1 Department of Geography, University of California, Davis, the Department of Pediatrics, Stanford University, Stanford, California, and the National Institute of Child Health and Human Development, Bethesda, Maryland
We write this review because of the notable confusion that surrounds the matter of primary malabsorption of lactose by the adult and the desirability of encouraging consumption of milk among those people who cannot digest lactose.* This problem is especially encountered among children of ethnic groups-including most minorities in the United States-who develop high incidences of lactose malabsorption in the years following weaning. Three official bodies have come out in firm support of the policy of encouraging milk use by children, particularly in those parts of the world where childhood malnutrition is commonplace.1-3 Their conclusions, however, were not arrived at independently, but derived in considerable measure from the position of certain participants in a 1971 working group meeting, of the Protein Advisory Group of the United Nations, on milk intolerance.4 Since that meeting, many additional studies have been completed, and we feel that a review such as this is timely in placing the matter in perspective for pediatricians who deal with the problem on a daily basis.
LACTOSE MALABSORPTION VIEWED IN A SOCIAL CONTEXT
The role of dairy products in human diet is a subject of public discussion,5 and relates not only to lactose malabsorption, but to milk allergy, hypercholesterolemia, myocardial infarction, and other health concerns. Because of public involvement, we turn first to the societal context in which various forces-social, economic, and professional-are being brought to bear on the problem of lactose digestion. There are strong groups-the dairy industry, various federal and state agencies, and many nutritionists-who have a commitment to encouraging milk use domestically and internationally, especially among children.
Submitted on June 16, 1976