Appendix Table D6Association between lactose intake and metabolism and bone mineral density (BMD, g/cm2)

Study Difference in Daily Ca++ Intake in Comparison GroupsComparisonOutcomeEstimateMean Difference (95% CI)
Lactose free diet

Country: Hong Kong
Elderly Chinese vegetarian women Ca++ intake difference in comparison groups: −94/Y

vs. lactovegetarians
BMD spine (L1±L4)0.04 (−0.02; 0.10)
BMD femoral neck0.02 (−0.02; 0.06)
BMD intertrochanteric area0.00 (−0.06; 0.06)
BMD ward triangle0.00 (−0.04; 0.04)

Country: New Zealand
Prepubertal children with a history of long-term milk avoidance Ca++ intake difference in comparison groups: 182/Y

baseline
Total body BMD0.04 (0.03; 0.05)
33% radius BMD0.06 (0.05; 0.07)
Lumbar spine (L2–4) BMD0.05 (0.03; 0.07)
Femoral neck BMD0.11 (0.07; 0.15)
Hip trochanter BMD0.10 (0.07; 0.12)
UD radius, z score−0.35 (−0.61; 0.21)
33% radius, z score0.38 (−0.10; 0.67)
Lumbar spine (L2–4), z score−0.22 (−0.39; −0.05)
Femoral neck, z score0.86 (0.20; 1.51)
Hip trochanter, z score0.69 (0.23; 1.15)
Total body, z score−0.28 (−0.40; −0.12)

Country: New Zealand
Prepubertal children with a history of long-term milk avoidance Ca++ intake difference in comparison groups: NR/NR

avoiders vs. reference healthy children
Total-body BMD0.13 (−0.17; 0.43)
Femoral neck BMD−1.11 (−2.00; −0.22)

Country: Taiwan
Postmenopausal Taiwanese women Ca++ intake difference in comparison groups: NR/NR

practice vs. nonlong-term vegan and nonvegan vegetarians
Lumbar spine BMD
continuous variable), vigorous physical activity (three categories), calcium, protein, and nonprotein kcal (as continuous variables)
−0.03 (−0.08; 0.01)
Femoral neck BMD−0.05 (−0.08; −0.02)

Country: Estonia
Adults Ca++ intake difference in comparison groups: NR/NR

vs. high (>4dL/day)
Femoral BMD (total)0.05 (0.10;0.01)
Spinal BMD (L1– L4) g/cm20.08 (0.14;0.01)
Du, 20026
Country: China Ca++ intake difference in comparison groups: NR/NR
No milk consumers vs. low milk group (<22±18 g/day)BMD (g/cm2); distal one-third radiusCrude0.03 (0.04;0.01)
Distal one-third ulna−0.02 (−0.03; 0.00)
Distal one-tenth radius0.03 (0.04;0.01)
Distal one-tenth ulna−0.02 (−0.04; 0.00)

group (>128±165 g/day)
Distal one-third radius0.04 (0.05;0.02)
Distal one-third ulna−0.02 (−0.03; 0.00)
Distal one-tenth radius0.04 (0.05;0.02)
Distal one-tenth ulna0.03 (0.05;0.02)

Country: Hong Kong
Elderly Chinese vegetarian women Ca++ intake difference in comparison groups: NR/NR

vs. omnivores
BMD (g=cm2) spine (L1±L4)0.00 (−0.06; 0.06)
BMD (g=cm2) femoral neck−0.03 (−0.06; 0.00)
BMD (g=cm2) Intertrochanteric area−0.04 (−0.09; 0.01)
BMD (g=cm2) ward triangle0.05 (0.08;0.02)
Genetic polymorphism

Country: Austria
Postmenopausal women Ca++ intake difference in comparison groups: 0.55/Y
Lumbar BMD0.07 (0.01; 0.13)
Femoral neck0.05 (0.01; 0.09)
Total hip0.07 (0.02; 0.12)
Ward’s triangle0.06 (0.01; 0.11)
Lumbar BMD0.00 (−0.05; 0.05)
Femoral neck0.01 (−0.03; 0.05)
Total hip0.03 (−0.01; 0.07)
Ward’s triangle0.02 (−0.02; 0.06)
Lumbar BMD0.07 (0.03; 0.11)
Femoral neck0.04 (0.01; 0.08)
Total hip0.04 (0.00; 0.08)
Ward’s triangle0.04 (0.00; 0.08)

Country: Austria
Postmenopausal women Ca++ intake difference in comparison groups: 349/Y
Lumbar BMD0.07 (−0.01; 0.15)
Femoral neck BMD [g/cm2]0.05 (0.00; 0.10)
Total hip BMD0.07 (0.01; 0.13)

Country: Finland
Young men Ca++ intake difference in comparison groups: NR/NR
Lumbar spine BMD (g/cm2)0.05 (−0.49; 0.59)
Femoral neck BMD (g/cm2)0.04 (−0.59; 0.67)
Trochanter BMD0.04 (−0.45; 0.53)
Total hip BMD0.03 (−0.44; 0.50)
BMD, lumbar spine
weight, smoking, alcohol consumption and current exercise
0.03 (−0.03; 0.09)
BMD, femoral neck0.01 (−0.05; 0.08)
BMD, total hip0.02 (−0.04; 0.09)
C/T vs. C/CLumbar spine BMDCrude0.01 (−0.60; 0.63)
Femoral neck BMD0.01 (−0.50; 0.52)
Trochanter BMD−0.01 (−0.56; 0.55)
Total hip BMD0.00 (−0.49; 0.50)
BMD, lumbar spine
weight, smoking, alcohol consumption and current exercise
0.05 (−0.01; 0.10)
BMD, femoral neck0.01 (−0.05; 0.08)
BMD, total hip0.02 (−0.04; 0.08)
Lumbar spine BMD0.04 (−0.50; 0.57)
Femoral neck BMD0.03 (−0.59; 0.64)
Trochanter BMD0.04 (−0.46; 0.55)
Total hip BMD0.03 (−0.45; 0.51)
BMD, lumbar spine
weight, smoking, alcohol consumption and current exercise
−0.01 (−0.06; 0.03)
BMD, femoral neck0.00 (−0.06; 0.06)
BMD, total hip0.00 (−0.05; 0.06)

Country: Estonia
Adults Ca++ intake difference in comparison groups: NR/NR
Femoral BMD (total)Crude−0.03 (−0.07; 0.02)
Spinal BMD (L1– L4)−0.01 (−0.07; 0.05)
Femoral BMD (total)−0.03 (−0.07; 0.01)
Spinal BMD (L1– L4)−0.02 (−0.07; 0.03)
Femoral BMD (total)0.00 (−0.03; 0.04)
Spinal BMD (L1– L4)0.00 (−0.05; 0.05)
Femoral BMD (total)0.03 (−0.01; 0.07)
Spinal BMD (L1– L4)0.02 (−0.03; 0.06)
Lactose intolerance
Corazza, 19954
Country: Italy
Postmenopausal women Ca++ intake difference in comparison groups: −246/Y
Lactose malabsorbers with symptoms of intolerance vs. without symptomsBMD z scoreCrude−0.60 (−1.17; −0.03)

Country: Italy
Adults Ca++ intake difference in comparison groups: −240/Y
BMD (T-score): lumbar spine−0.98 (−1.32; −0.64)
BMD (T-score): femoral neck−0.94 (−1.28; −0.60)
BMD (z-score): lumbar spine−0.90 (−1.24; −0.56)
BMD (z-score): femoral neck−0.88 (−1.22; −0.54)
Corazza, 19954
Country: Italy
Postmenopausal women Ca++ intake difference in comparison groups: −138/NR
Lactose intolerace (clinical diagnosis) vs. notBMD z scoreCrude0.30 (−0.16; 0.76)

Country: Estonia
Adults Ca++ intake difference in comparison groups: NR/NR

vs. not
Femoral BMD (total) g/cm2−0.01 (−0.06; 0.04)
Spinal BMD (L1– L4) g/cm2−0.04 (−0.10; 0.02)

Country: Israel
Adults Ca++ intake difference in comparison groups: NR/NR

population; BMD z-Scores
BMD z-Scores: femoral neck in Premenopausal women0.15 (−0.20; 0.50)
Hip in premenopausal women0.25 (−0.01; 0.51)
L2–L4 in premenopausal women−0.59 (−0.96; −0.22)
Femoral neck in postmenopausal women−0.07 (−0.38; 0.24)
Hip in postmenopausal women0.04 (−0.28; 0.36)
L2–L4 in Postmenopausal women−0.87 (−0.95; −0.79)
Femoral neck in men−0.45 (−0.88; −0.02)
Hip in men−0.45 (−0.92; 0.02)
L2–L4 in men−1.32 (−.74; −0.90)
Lactose malabsorption

Country: Finland
Perimenopausal women Ca++ intake difference in comparison groups: −280/Y

tolerance test
Femoral BMD, no fractures
menopausal status, weight, and HRT history
−0.01 (−0.03; 0.01)
Femoral BMD, wrist fractures−0.01 (−0.06; 0.04)
Femoral BMD, ankle fractures−0.03 (−0.12; 0.06)
Femoral BMD, tibial fracture−0.14 (−0.23; −0.05)
Spinal bone BMD, no fractures−0.01 (−0.03; 0.02)
Spinal bone BMD, wrist fractures−0.04 (−0.08; 0.00)
Spinal bone BMD, ankle fracture−0.05 (−0.15; 0.05)
Spinal bone BMD, tibial fracture−0.08 (−0.17; 0.00)
Honkanen, 199616
Country: Finland
perimenopausal women Ca++ intake difference in comparison groups: −270/Y
Positive vs. negative lactose tolerance testFemoral BMDAdjusted for Calcium intake, weight, age, years since menopause, HRT0.15 (−18.02; 18.32)
Positive vs. negative lactose tolerance test in premenopausalSpinal BMDCrude0.01 (−0.04; 0.06)
Positive vs. negative lactose tolerance test in postmenopausal−0.05 (−0.09; −0.01)
Positive vs. negative lactose tolerance test in postmenopausal, hormone replacement therapy 6 months or more−0.08 (−0.12; −0.03)
Positive vs. negative lactose tolerance test in postmenopausal, no HRT−0.02 (−0.07; 0.04)
Positive vs. negative lactose tolerance test in premenopausal−0.02 (−0.07; 0.04)
Positive vs. negative lactose tolerance test in postmenopausal−0.03 (−0.06; 0.00)
Positive vs. negative lactose tolerance test in postmenopausal, hormone replacement therapy 6 months or more−0.05 (−0.09; −0.01)
Positive vs. negative lactose tolerance test in postmenopausal, no HRT−0.01 (−0.06; 0.04)

Country: Italy
Adults Ca++ intake difference in comparison groups: −54/Y
BMD (T-score): lumbar spine−0.22 (−0.49; 0.05)
BMD (T-score): femoral neck−0.21 (−0.48; 0.06)
BMD (z-score): lumbar spine−0.25 (−0.52; 0.02)
BMD (z-score): femoral neck−0.22 (−0.49; 0.05)
Corazza, 19954
Country: Italy
Postmenopausal women Ca++ intake difference in comparison groups: −2/N
Lactose malabsroption vs. noBMD z scoreCrude−0.30 (−0.77; 0.17)

Country: Finland
Adults Ca++ intake difference in comparison groups: NR/NR
Malabsorbers vs. absorbers (men only)Mineral density distal radius0.01 (−0.02; 0.03)
Malabsorbers vs. absorbers (women only)Mineral density distal radius0.03 (0.00; 0.05)

Country: Austria
Adults Ca++ intake difference in comparison groups: NR/NR
Moderate lactose malabsorption vs. noDEXA (radial) (g/cm2)−0.01 (−0.19; 0.17)
Severe lactose malabsorption vs. noDEXA (radial)(g/cm2)−0.07 (−0.29; 0.15)
Severe lactose malabsorption vs. moderateDEXA (radial)(g/cm2)−0.06 (−0.21; 0.09)
Horowitz, 198717
Country: Austria
Postmenopausal women Ca++ intake difference in comparison groups: NR/NR
Lactose malabsroption vs. noBMD of the right forearm, mg/mlCrude−17.00 (−61.44; 27.44)

Country: Finland
Adults Ca++ intake difference in comparison groups: NR/NR

only)
Bone mineral linear density (g/cm), distal radius0.00 (−0.17; 0.17)
Bone mineral linear density (g/cm), midshaft radius0.06 (−0.09; 0.21)
Bone mineral linear density (g/cm), midshaft ulna0.02 (−0.12; 0.16)
Malabsorbers vs. absorbers (women only)Bone mineral linear density (g/cm), distal radius0.03 (−0.10; 0.16)
Bone mineral linear density (g/cm), midshaft radius0.02 (−0.08; 0.12)
Bone mineral linear density (g/cm), midshaft ulna0.03 (−0.05; 0.11)

Bold – statistically significant

From: Appendix D, Evidence Tables

Cover of Lactose Intolerance and Health
Lactose Intolerance and Health.
Evidence Reports/Technology Assessments, No. 192.
Wilt TJ, Shaukat A, Shamliyan T, et al.

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