Am J Clin Nutr. 2024 Dec;120(6):1335-1343.doi: 10.1016/j.ajcnut.2024.09.031. Epub 2024 Oct 5.

Alexandra Cohen ¹, Jennifer Li ², James Butcher ², Ruth Singleton ³, Pauline Barbeau ³, Alain Stintzi ², David R Mack ⁴

Author information

¹Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.

²Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.

³CHEO Research Institute, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.

⁴Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; CHEO Research Institute, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada. Electronic address: dmack@cheo.on.ca.

Abstract

Background: Dietary exclusion of lactose from patients with inflammatory bowel disease (IBD) persists with speculation that deleterious effects are mediated through intestinal microbes.

Objectives: To compare IBD characteristics and changes in the intestinal microbiome (IM) at diagnosis in children with and without lactose malabsorption (LM).

Methods: A cross-sectional cohort of children (8-17 y of age) diagnosed with Crohn's disease [n = 149 (63%)] or ulcerative colitis (n = 86) that had undergone lactose breath hydrogen testing was evaluated. The IM of mucosal luminal aspirates was profiled at the time of diagnosis using 16S ribosomal ribonucleic acid gene amplicon sequencing of the V6 hypervariable region.

Results: Of the 235 children, 61 (26%) had LM. Microbial characterization yielded differences in bacterial differential abundance between children who could and could not absorb lactose, which varied by intestinal site and between subtypes of IBD. There were no differences in the ages [13.2 ± 3.0 y (mean ± standard deviation) compared with 12.7 ± 3.4 y; P = 0.25], sex (P = 0.88), extent of disease involvement or severity of disease at presentation (P = 0.74) when comparing those that could or could not absorb lactose nor was there a difference in the need for initiation of biological agents (P = 0.43) during 2 y of follow-up.

Conclusions: LM does not affect the clinical presentation or outcomes of children with IBD. However, this study establishes that a single nonabsorbed fermentable food product can alter the IM in both a regional and disease-specific manner. As we continue to learn more about the pathophysiology of IBD and the role of the IM in disease onset and progression, it would be of benefit to examine the impact of other potential fermentable nutrients and their products on IBD outcomes.