{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T18:43:38Z","timestamp":1775933018691,"version":"3.50.1"},"reference-count":47,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2018,5,1]],"date-time":"2018-05-01T00:00:00Z","timestamp":1525132800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Adult-type hypolactasia (ATH) is a clinical syndrome of primary lactase deficiency. A lactose-free diet is advisable to avoid the symptoms linked to the condition, but this potentially creates problems for optimal bone mineralization due to reduced calcium intake. To evaluate the effect of the lactose-free diet on the bone mineral status (BMS), we compared the phalangeal BMS of adolescents with ATH to that of peers on a normal diet. Also, we analyzed the correlations between BMS and dietary behavior, physical exercise, and calcium and vitamin D intake. A total of 102 cases and 102 healthy controls filled out a diet record and underwent phalangeal Quantitative Ultrasound (QUS). No difference in BMS was observed. The time spent on lactose-free diet (4.8 \u00b1 3.1 years) was inversely correlated to the BMS. More than 98% of cases consumed lactose-free milk, but calcium and vitamin D intake were significantly lower. Calcium intake was correlated to physical exercise but not to BMS. Our results suggest that a lactose-free diet does not affect the phalangeal BMS of adolescents with primary lactase deficiency when their diet includes lactose-free cow\u2019s milk. However, there is still a significantly lower calcium intake than in the population reference. The inverse correlation observed between the BMS and the time spent on a lactose-free diet suggests that a long-term follow-up is advisable.<\/jats:p>","DOI":"10.3390\/nu10050558","type":"journal-article","created":{"date-parts":[[2018,5,3]],"date-time":"2018-05-03T03:20:27Z","timestamp":1525317627000},"page":"558","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Assessment of Lactose-Free Diet on the Phalangeal Bone Mineral Status in Italian Adolescents Affected by Adult-Type Hypolactasia"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5129-3419","authenticated-orcid":false,"given":"Alessandro","family":"Baldan","sequence":"first","affiliation":[{"name":"Department of Medical Sciences, Section of Pediatrics, University of Ferrara, Via A. Moro 8, 44124 Ferrara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sylvie","family":"Tagliati","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, Section of Pediatrics, University of Ferrara, Via A. Moro 8, 44124 Ferrara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniela","family":"Saccomandi","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, Section of Pediatrics, University of Ferrara, Via A. Moro 8, 44124 Ferrara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Brusaferro","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, Section of Pediatrics, University of Ferrara, Via A. Moro 8, 44124 Ferrara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Busoli","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, Section of Pediatrics, University of Ferrara, Via A. Moro 8, 44124 Ferrara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Scala","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, Section of Pediatrics, University of Ferrara, Via A. Moro 8, 44124 Ferrara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristina","family":"Malaventura","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, Section of Pediatrics, University of Ferrara, Via A. Moro 8, 44124 Ferrara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8201-2416","authenticated-orcid":false,"given":"Giuseppe","family":"Maggiore","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, Section of Pediatrics, University of Ferrara, Via A. Moro 8, 44124 Ferrara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caterina","family":"Borgna-Pignatti","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, Section of Pediatrics, University of Ferrara, Via A. Moro 8, 44124 Ferrara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2018,5,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1146\/annurev.genet.37.110801.143820","article-title":"Genetics of lactase persistence and lactose intolerance","volume":"37","author":"Swallow","year":"2003","journal-title":"Annu. Rev. Genet."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1038\/ng826","article-title":"Identification of a variant associated with adult-type hypolactasia","volume":"30","author":"Enattah","year":"2002","journal-title":"Nat. Genet."},{"key":"ref_3","first-page":"605","article-title":"Phylogenetic analysis of the evolution of lactose digestion in adults","volume":"69","author":"Holden","year":"1997","journal-title":"Hum. Biol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.1136\/bmj.39252.524375.80","article-title":"Lactose intolerance","volume":"334","author":"Bhatnagar","year":"2007","journal-title":"BMJ"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1279","DOI":"10.1542\/peds.2006-1721","article-title":"Lactose intolerance in infants, children, and adolescents","volume":"118","author":"Heyman","year":"2006","journal-title":"Pediatrics"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1542\/peds.2005-2822","article-title":"Optimizing bone health and calcium intakes of infants, children, and adolescents","volume":"117","author":"Greer","year":"2006","journal-title":"Pediatrics"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1287","DOI":"10.1172\/JCI119287","article-title":"Calcium-enriched foods and bone mass growth in prepubertal girls: A randomized, double-blind, placebo-controlled trial","volume":"99","author":"Bonjour","year":"1997","journal-title":"J. Clin. Investig."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1007\/s00198-011-1671-5","article-title":"Epigenetic influences in the developmental origins of osteoporosis","volume":"23","author":"Holroyd","year":"2012","journal-title":"Osteoporos. Int."},{"key":"ref_9","first-page":"95","article-title":"Factors affecting bone mineral density in high school girls","volume":"105","author":"Turner","year":"1992","journal-title":"N. Z. Med. J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2017","DOI":"10.1002\/jbmr.5650101223","article-title":"Segregation analysis and variance components analysis of bone mineral density in healthy families","volume":"10","author":"Jouanny","year":"1995","journal-title":"J. Bone Miner. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1273","DOI":"10.1093\/rheumatology\/kel028","article-title":"Quantitative ultrasonometry of the calcaneus in children with juvenile idiopathic arthritis","volume":"45","author":"Kutilek","year":"2006","journal-title":"Rheumatology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/S0899-9007(00)00545-1","article-title":"Growth failure and decreased ultrasound parameters of bone density in children with inflammatory bowel disease","volume":"17","author":"Bayer","year":"2001","journal-title":"Nutrition"},{"key":"ref_13","first-page":"169","article-title":"Use of quantitative ultrasound to assess osteopenia in children with Crohn disease","volume":"35","author":"Levine","year":"2002","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1002\/j.1536-4801.2004.tb00899.x","article-title":"Bone quantitative ultrasound and bone mineral density in children with celiac disease","volume":"39","author":"Hartman","year":"2004","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1038\/ejhg.2012.52","article-title":"Lactose malabsorption is a risk factor for decreased bone mineral density in pancreatic insufficient cystic fibrosis patients","volume":"20","author":"Sands","year":"2012","journal-title":"Eur. J. Hum. Genet."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"980","DOI":"10.1515\/CCLM.2008.189","article-title":"Genetic testing for adult-type hypolactasia in Italian families","volume":"46","author":"Mottes","year":"2008","journal-title":"Clin. Chem. Lab. Med."},{"key":"ref_17","unstructured":"Zerfas, A.J. (1985). Checking Continuous Measures: Manual for Anthropometry, Division of Epidemiology, School of Public Health, University of California."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1038\/sj.ejcn.1601314","article-title":"Italian cross-sectional growth charts for height, weight and BMI (6\u201320 y)","volume":"56","author":"Cacciari","year":"2002","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_19","unstructured":"Societ\u00e0 Italiana di Nutrizione Umana (SINU) (2012). Livelli di Assunzione di Riferimento di Nutrienti ed Energia per la Popolazione Italiana (LARN), SINU. Revisione 2012."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1002\/jbmr.5650110602","article-title":"Noninvasive assessment of bone mineral and structure: State of the art","volume":"11","author":"Genant","year":"1996","journal-title":"J. Bone Miner. Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1007\/BF01623454","article-title":"The role of ultrasound in the assessment of osteoporosis: A review","volume":"7","author":"Njeh","year":"1997","journal-title":"Osteoporos. Int."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1203\/01.PDR.0000069845.27657.EB","article-title":"Assessment of bone quality by quantitative ultrasound of proximal phalanges of the hand and fracture rate in children and adolescents with bone and mineral disorders","volume":"54","author":"Baroncelli","year":"2003","journal-title":"Pediatr. Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"3651","DOI":"10.1210\/jc.2004-0124","article-title":"Official positions of the international society for clinical densitometry","volume":"89","author":"Lewiecki","year":"2004","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/j.bone.2005.12.010","article-title":"Cross-sectional reference data for phalangeal quantitative ultrasound from early childhood to young-adulthood according to gender, age, skeletal growth, and pubertal development","volume":"39","author":"Baroncelli","year":"2006","journal-title":"Bone"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1203\/00006450-200105000-00017","article-title":"Bone quality assessment by quantitative ultrasound of proximal phalanxes of the hand in healthy subjects aged 3\u201321 years","volume":"49","author":"Baroncelli","year":"2001","journal-title":"Pediatr. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1007\/BF01072197","article-title":"Use of breath hydrogen (H2) in the study of carbohydrate absorption","volume":"22","author":"Bond","year":"1977","journal-title":"Am. J. Dig. Dis."},{"key":"ref_27","first-page":"33","article-title":"Parmigiano Reggiano cheese and bone health","volume":"8","author":"Pampaloni","year":"2011","journal-title":"Clin. Cases Miner. Bone Metab."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e280","DOI":"10.1016\/j.dld.2017.09.103","article-title":"Effect of lactose-free diet on phalangeal bone mineral status of Italian adolescents with adult type hypolactasia","volume":"49","author":"Baldan","year":"2017","journal-title":"Dig. Liver Dis."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1002\/ajhb.20411","article-title":"Does milk make children grow? Relationships between milk consumption and height in NHANES 1999\u20132002","volume":"17","author":"Wiley","year":"2005","journal-title":"Am. J. Hum. Biol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1111\/j.1525-1497.2001.04189.x","article-title":"Comparison of the mineral content of tap water and bottled waters","volume":"16","author":"Azoulay","year":"2001","journal-title":"J. Gen. Intern. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1093\/ajcn\/84.2.371","article-title":"Absorbability and utility of calcium in mineral waters","volume":"84","author":"Heaney","year":"2006","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1203\/PDR.0b013e318163a286","article-title":"Quantitative ultrasound methods to assess bone mineral status in children: Technical characteristics, performance, and clinical application","volume":"63","author":"Baroncelli","year":"2008","journal-title":"Pediatr. Res."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1007\/s001980200039","article-title":"Skeletal status in children, adolescents and young adults with end-stage renal failure treated with hemo- or peritoneal dialysis","volume":"13","author":"Pluskiewicz","year":"2002","journal-title":"Osteoporos. Int."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1007\/BF01622735","article-title":"Pathways of transmission of ultrasound energy through the distal metaphysis of the second phalanx of pigs: An in vitro study","volume":"6","author":"Cadossi","year":"1996","journal-title":"Osteoporos. Int."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1007\/s198-002-8338-8","article-title":"German pediatric reference data for quantitative transverse transmission ultrasound of finger phalanges","volume":"13","author":"Barkmann","year":"2002","journal-title":"Osteoporos. Int."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1016\/j.ultrasmedbio.2003.10.023","article-title":"Quantitative ultrasound in the assessment of skeletal status in children and adolescents","volume":"30","author":"Halaba","year":"2004","journal-title":"Ultrasound Med. Biol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1126","DOI":"10.1359\/jbmr.060417","article-title":"Relationship between bone quantitative ultrasound and fractures: A meta-analysis","volume":"21","author":"Palma","year":"2006","journal-title":"J. Bone Miner. Res."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2147","DOI":"10.1007\/s00467-014-2834-3","article-title":"Bone health in children and adolescents with steroid-sensitive nephrotic syndrome assessed by DXA and QUS","volume":"29","author":"Aceto","year":"2014","journal-title":"Pediatr. Nephrol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.jocd.2007.12.011","article-title":"Quantitative ultrasound in the management of osteoporosis: The 2007 ISCD Official Positions","volume":"11","author":"Krieg","year":"2008","journal-title":"J. Clin. Densitom."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1016\/j.bone.2007.07.008","article-title":"Osteoporosis in children and adolescents","volume":"41","author":"Bianchi","year":"2007","journal-title":"Bone"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1097\/MPG.0b013e3182380604","article-title":"Lactose malabsorption, calcium intake, and bone mass in children and adolescents","volume":"54","author":"Medeiros","year":"2012","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"e669","DOI":"10.1542\/peds.2006-1240","article-title":"Perceived milk intolerance is related to bone mineral content in 10- to 13-year-old female adolescents","volume":"120","author":"Matlik","year":"2007","journal-title":"Pediatrics"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Winzenberg, T.M., Shaw, K.A., Fryer, J., and Jones, G. (2006). Calcium supplementation for improving bone mineral density in children. Cochrane Database Syst. Rev.","DOI":"10.1002\/14651858.CD005119"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1542\/peds.2004-0548","article-title":"Calcium, dairy products, and bone health in children and young adults: A reevaluation of the evidence","volume":"115","author":"Lanou","year":"2005","journal-title":"Pediatrics"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1016\/S8756-3282(01)00675-5","article-title":"Modifiable determinants of bone status in young women","volume":"30","author":"Lloyd","year":"2002","journal-title":"Bone"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1359\/jbmr.1998.13.1.133","article-title":"Associations of physical activity and calcium intake with bone mass and size in healthy women at different ages","volume":"13","author":"Vuori","year":"1998","journal-title":"J. Bone Miner. Res."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1089\/152460902317586029","article-title":"Lifetime physical activity and calcium intake related to bone density in young women","volume":"11","author":"Wallace","year":"2002","journal-title":"J. Womens Health Gend. Based Med."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/10\/5\/558\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T15:02:46Z","timestamp":1760194966000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/10\/5\/558"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,5,1]]},"references-count":47,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2018,5]]}},"alternative-id":["nu10050558"],"URL":"https:\/\/doi.org\/10.3390\/nu10050558","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,5,1]]}}}