Items in AFP with MESH term: Calcium, Dietary
Lactose Intolerance - Article
ABSTRACT: Persons with lactose intolerance are unable to digest significant amounts of lactose because of a genetically inadequate amount of the enzyme lactase. Common symptoms include abdominal pain and bloating, excessive flatus, and watery stool following the ingestion of foods containing lactose. Lactase deficiency is present in up to 15 percent of persons of northern European descent, up to 80 percent of blacks and Latinos, and up to 100 percent of American Indians and Asians. A sizable number of adults believe they are lactose intolerant but do not actually have impaired lactose digestion, and some persons with lactase deficiency can tolerate moderate amounts of ingested lactose. A diagnosis of lactose intolerance can usually be made with a careful history supported by dietary manipulation. If necessary, diagnosis can be confirmed by using a breath hydrogen or lactose tolerance test. Treatment consists primarily of avoiding lactose-containing foods. Lactase enzyme supplements may be helpful. The degree of lactose malabsorption varies greatly among patients with lactose intolerance, but most of them can ingest up to 12 oz of milk daily without symptoms. Lactose-intolerant patients must ensure adequate calcium intake.
ABSTRACT: The association between nutrition and health has been clearly documented. Primary care physicians are expected to address nutrition and dietary behavior issues with their patients in the context of a brief clinical encounter. This article proposes the use of a short interview form, with specific suggestions for behavior changes that family physicians can use to help their patients meet currently accepted dietary guidelines. Answers to the questions on the interview form provide the physician with an overall sense of the patient's daily eating habits and help to identify major sources of saturated fat in the patient's diet. The patient is asked about the number of meals and snacks eaten in a 24-hour period, dining-out habits and frequency of consumption of fruits, vegetables, meats, poultry, fish, dairy products and desserts. Documentation of dietary changes can be accomplished using the suggested nutrition history form, and improvements in nutritional status can be measured using weight, blood pressure and laboratory test data.
Calcium Supplementation in Postmenopausal Women - Cochrane for Clinicians
Calcium and Prevention of Colorectal Cancer - Cochrane for Clinicians
ABSTRACT: Stress fractures are common injuries in athletes and military recruits. These injuries occur more commonly in lower extremities than in upper extremities. Stress fractures should be considered in patients who present with tenderness or edema after a recent increase in activity or repeated activity with limited rest. The differential diagnosis varies based on location, but commonly includes tendinopathy, compartment syndrome, and nerve or artery entrapment syndrome. Medial tibial stress syndrome (shin splints) can be distinguished from tibial stress fractures by diffuse tenderness along the length of the posteromedial tibial shaft and a lack of edema. When stress fracture is suspected, plain radiography should be obtained initially and, if negative, may be repeated after two to three weeks for greater accuracy. If an urgent diagnosis is needed, triple-phase bone scintigraphy or magnetic resonance imaging should be considered. Both modalities have a similar sensitivity, but magnetic resonance imaging has greater specificity. Treatment of stress fractures consists of activity modification, including the use of nonweight-bearing crutches if needed for pain relief. Analgesics are appropriate to relieve pain, and pneumatic bracing can be used to facilitate healing. After the pain is resolved and the examination shows improvement, patients may gradually increase their level of activity. Surgical consultation may be appropriate for patients with stress fractures in high-risk locations, nonunion, or recurrent stress fractures. Prevention of stress fractures has been studied in military personnel, but more research is needed in other populations.
IOM Recommends Increased Calcium Intakes - Special Medical Reports
ACOG Releases Practice Bulletin on Osteoporosis - Practice Guidelines