Genetics of lactase persistence and lactose intolerance

Annu Rev Genet. 2003:37:197-219. doi: 10.1146/annurev.genet.37.110801.143820.


The enzyme lactase that is located in the villus enterocytes of the small intestine is responsible for digestion of lactose in milk. Lactase activity is high and vital during infancy, but in most mammals, including most humans, lactase activity declines after the weaning phase. In other healthy humans, lactase activity persists at a high level throughout adult life, enabling them to digest lactose as adults. This dominantly inherited genetic trait is known as lactase persistence. The distribution of these different lactase phenotypes in human populations is highly variable and is controlled by a polymorphic element cis-acting to the lactase gene. A putative causal nucleotide change has been identified and occurs on the background of a very extended haplotype that is frequent in Northern Europeans, where lactase persistence is frequent. This single nucleotide polymorphism is located 14 kb upstream from the start of transcription of lactase in an intron of the adjacent gene MCM6. This change does not, however, explain all the variation in lactase expression.

Publication types

  • Review

MeSH terms

  • Gene Frequency
  • Genetics, Population*
  • Humans
  • Lactase / genetics*
  • Lactase / metabolism
  • Lactose / metabolism*
  • Lactose Intolerance / genetics*
  • Polymorphism, Genetic
  • Promoter Regions, Genetic


  • Lactase
  • Lactose