Human Genetics

, Volume 62, Issue 2, pp 152–157 | Cite as

Distribution of physiological adult lactase phenotypes, lactose absorber and malabsorber, in Germany

  • G. Flatz
  • J. N. Howell
  • J. Doench
  • S.D. Flatz
Original Investigations


A total of 1805 apparently healthy, adult and adolescent Germans (1572 males and 233 females with a mean age of 20.3 years) were examined for lactose absorption capacity employing a field version of the breath hydrogen (H2) test. The diagnostic parameter, maximal change of breath hydrogen concentration 120 or 150 min after a load of 50 g lactose, showed a bimodal distribution, separating lactose absorbers (n-1537, 85.2%) and lactose malabsorbers (n=268, 14.8%). The distribution of the adult lactase phenotypes was independent of age, sex, and educational status. The incidence of gastrointestinal symptoms after lactose administration demonstrated the incongruity of lactose malabsorption and lactose intolerance. In addition to grouping by residdence, the probands were classified according to the birthplaces of their grandparents in order to reconstruct the distribution pattern of the lactase phenotypes prior to World War I, a period of relative population stability. Considerable differences in the frequency of lactose malabsorption were found in regions corresponding to traditional ethnic groups within the German population: northwest Germany 6–9%, west and south 13–14%, southwest 23%, east (including formerly German territories east of rivers Oder and Neisse) 22%. These differences are discussed with reference to population history. The present fairly even distribution of the lactase phenotypes in West Germany is the result of internal migrations at the end of World War II.


Lactose Hydrogen Concentration Internal Migration Absorption Capacity Educational Status 
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  1. Auricchio S, Rubino G, Semenza G, Landolt M, Prader A (1963) Disaccharidase activities in human intestinal mucosa. Enzymol Biol Clin 3:193–208Google Scholar
  2. Bayoumi RAL, Flatz SD, Kühnau W, Flatz G (1982) Beja and Nilotes: Nomadic pastoralist groups in the Sudan with opposite distributions of the adult lactase phenotypes. Am J Phys Anthropol 58:173–178Google Scholar
  3. Blaxter KL (1961) Lactation and the growth of the young. In: Kow SK, Cowie AT (eds) Milk: the mammary gland and its secretion, vol 2. Academic Press, New York, p 329Google Scholar
  4. Busk HE, Dahlerup B, Lytzen T, Binder V, Gudmand-Hoyer E (1975) The incidence of lactose malabsorption in ulcerative colitis. Scand J Gastroenterol 10:263–265Google Scholar
  5. Cavalli-Sforza LL, Bodmer WF (1971) The genetics of human populations. Freeman, San Francisco, pp 63–64Google Scholar
  6. Cook GC, Al-Torki MT (1975) High intestinal lactase concentrations in adult Arabs in Saudi Arabia. Br Med J 3:135–136Google Scholar
  7. Cuddenec Y, Delbrück H, Flatz G (to be published) Distribution of the adult lactase phenotypes, lactose absorber and malabsorber, in a group of 131 French army recruits. Gastroenterol Clin BiolGoogle Scholar
  8. Dahlqvist A (1974) Enzyme deficiency and malabsorption of carbohydrates. In: Sipple HL, McNutt KW (eds) Sugars in nutrition. Academic Press, New York, pp 187–214Google Scholar
  9. Dahlqvist A, Lindquist B (1971) Lactose intolerance and protein mal-nutrition. Acta Paediatr Scand 60:488–494Google Scholar
  10. Flatz G, Bernsau I, Behrens A (1982) Lactose absorption and mal-absorption in healthy German children: improved phenotypic resolution by simultaneous determination of breath hydrogen and carbon dioxide. Eur J Pediatr 138:304–306Google Scholar
  11. Flatz G, Rotthauwe HW (1973) Lactose nutrition and natural selection. Lancet 2:76–77Google Scholar
  12. Gudmand-Høyer E, Dahlqvist A, Jarnum S (1969) Specific small intestinal lactase deficiency in adults. Scand J Gastroenterol 4: 377–386Google Scholar
  13. Haemmerli UP, Kistler H, Ammann R, Marthaler G, Semenza S (1965) Acquired milk intolerance in the adult caused by lactose malabsorption due to a selective deficiency in intestinal lactase activity. Am J Med 38:7–30Google Scholar
  14. Howell JN, Schockenhoff T, Flatz G (1981) Population screening for the human adult lactase phenotypes with a multiple breaths version of the breath hydrogen test. Hum Genet 57:276–278Google Scholar
  15. Johnson JD, Kretchmer N, Simoons FJ (1974) Lactose malabsorption: its biology and history. Adv Pediatr 21:197–237Google Scholar
  16. Kretchmer N, Ransome-Kuti O, Hurwitz R, Dungy C, Alakiya W (1971) Intestinal absorption of lactose in Nigerian ethnic groups. Lancet 2:392–395Google Scholar
  17. Leichter J (1972) Lactose tolerance in a Slavic population. Dig Dis Sci 17:73–76Google Scholar
  18. Luyken R, Luyken-Koning FWM, Immikhuizen T (1971) Lactose intolerance in Surinam. Trop Geogr Med 23:54–58Google Scholar
  19. Madzarovova-Nohejlova J (1974) Dünndarmdisaccharidaseaktivität bei Erwachsenen. Dtsch Z Verdau Stoffwechselkr 34:229–231Google Scholar
  20. Marenco G, Ghibaudi D, Meraviglia A (1970) Intolleranza al lattosio nell'adulto. Minerva Pediatr 22:505–513Google Scholar
  21. Mourant AE, Kopec AC, Domaniewska-Sobczak K (1976) The distribution of the human blood groups and other polymorphisms. Oxford University Press, LondonGoogle Scholar
  22. Newcomer AD, McGill DB, Thomas PJ, Hofmann AF (1975) Prospective comparison of indirect methods for detecting lactase deficiency. N Engl J Med 293:1232–1236Google Scholar
  23. O'Morain, C, Loubiere M, Rampal P, Sudaka P, Delmont J (1978) Etude comparative de l'insuffisance en lactase de deux populations adultes differentes. Acta Gastroenterol Belg 41:56–63Google Scholar
  24. Rahimi AG, Delbrück H, Haeckel R, Goedde HW, Flatz G (1976) Persistence of high intestinal lactase activity (lactose tolerance) in Afghanistan. Hum Genet 34:57–62Google Scholar
  25. Rosenkranz W, Hadorn B, Müller W, Heinz-Erian P, Hensen Ch, Flatz G (1982) Distribution of human adult lactase phenotypes in the population of Austria. Hum Genet 62:158–161Google Scholar
  26. Rotthauwe HW, Emons D, Flatz G (1972) Die Häufigkeit der Laktose-Intoleranz bei gesunden Erwachsenen in Deutschland. Dtsch Med Wochenschr 97:376–380Google Scholar
  27. Sadre M, Karbasi K (1979) Lactose intolerance in Iran. Am J Clin Nutr 32:1948–1954Google Scholar
  28. Simoons FJ (1970) Primary adult lactose intolerance and the milking habit: a problem in biologic and cultural interrelations. II. A culture historical hypothesis. Dig Dis Sci 15:695–710Google Scholar
  29. Simoons FJ (1978) The geographic hypothesis and lactose malabsorption, a weighing of the evidence. Dig Dis Sci 23:963–980Google Scholar
  30. Vogel F, Motulsky AG (1979) Human genetics, problems and approaches. Springer, Heidelberg, pp 378–380Google Scholar

Copyright information

© Springer-Verlag 1982

Authors and Affiliations

  • G. Flatz
    • 1
  • J. N. Howell
    • 1
  • J. Doench
    • 1
  • S.D. Flatz
    • 1
  1. 1.Abteilung HumangenetikMedizinische Hochschule HannoverHannover 61Federal Republic of Germany

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