title: Determinants of geographic patterns of diseases: interaction of lactose/lactase status and sunshine exposure.
abstract: Geographic patterns of diseases depend on multilayered causes. However, the division of the world's population into two phenotypes regarding lactose digestion and sunshine exposure to fixed areas of the globe are two relatively slow changing variables. It is hypothesized that it is a vectorial interaction between these two variables that provide a backbone to risk modification of many diseases. Lactase non persistence status tends to follow sunshine exposure particularly in Europe but Lactase persistence status is also been shown to be related to pastoral life styles in spotty regions of Africa, Middle East and China. Current emphasis of research favours the modifying role of vitamin D and sunshine. Nevertheless it was demonstrated that national digester/nondigester status has mathematical relationships to geographic distribution of some diseases. These relationships are also similar to that described for the effects of latitude through sunshine and vitamin D. This observation raises a question as to how each one affects disease outcome. In this paper lactose/lactase interactions are first reviewed for eight exemplary diseases. Based on population findings and corroborative meta-analyses gleaned from the literature 6 types of interactions may be classified. Then in a preliminary fashion lactose digester and maldigester status are related to relative annual sunshine exposure. Further the relative national annual sunshine exposure is evaluated to outcomes of the same exemplary diseases. The patterns related to sunshine reflect that obtained with national lactase status proportions and also corroborate a literature review. However, correlations are weak to moderate and only ovarian cancer reached conventional statistical significance. Because these comparisons are based on modest number of national data firm conclusions cannot be made. However, it is argued that evolutionary pressures exerted by regional sunshine exposure may have had influence on a number of relevant genetic polymorphisms in parallel with lactase status. Furthermore influences of ancestral herding and dairy food consumption also may have exerted independent influences on either lactose phenotype. As such both discussed variables are postulated to exert parallel as well as independent effects on modifying geographic disease patterns. These could partly explain both north to south and west to east directional changes.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Jewish General Hospital, McGill University School of Medicine, Montreal, Quebec, Canada. aszilagy@gas.jgh.mcgill.ca
authors.forename: Andrew
authors.initials: A
authors.lastname: Szilagyi
mesh_terms: D015415:Biomarkers / Q000378:metabolism*; D004194:Disease; D005843:Geography; D006801:Humans; D043322:Lactase / Q000378:metabolism*; D007785:Lactose / Q000378:metabolism*; D013472:Sunlight; D014807:Vitamin D / Q000502:physiology
chemical_list: D015415:Biomarkers; D014807:Vitamin D; D043322:Lactase; D007785:Lactose