Characteristics, Availability, and Cost of Lactose-free Labelled

Products in Moroccan Supermarkets

Morad Guennouni

, Noureddine El Khoudri

, Loubna Zogaam Gharbi

, Aicha Bourrahouate

Brahim Admou

, and Abderraouf Hilali

Higher Institute of Health sciences, Hassan 1er university, Settat, Morocco

Faculty of Sciences, IbnTofail University, Kenitra, Morocco

Faculty of medecine and pharmacy of Marrakesh, Caddi Ayad university, Morocco

Keywords: Lactose Intolerance, Lactose-free products, Availability, characteristics, cost.

Abstract: Food products for dietary use is increasing over time including lactose-free products. These are used during

the follow-up of lactose-free diets by patients suffering from lactose intolerance. The implementation of a

quality control system by the manufacturers, has allowed to respect the safety of these foods by producing

lactose-free products by respecting the maximum dose of lactose allowed (10mg/kg). Five categories (LF

Milk, LF Yagourt, LF Cheese, Other LF dairy, and Other LF non-dairy) of lactose-free products were

available in the different sales sites. The present research identified 70 different lactose-free products, 23 of

which were dairy products and its derivatives and 47 non-dairy lactose-free products. The majority of products

were available on online sales sites. Moroccan supermarkets do not yet have an area reserved for lactose-free

products but for gluten-free products. The price of lactose-free products was two to three times more

expensive than their equivalents lactose containing. Hence, the need to encourage Moroccan companies to

develop lactose-free products and enrich them with nutrients such as vitamins and calcium.

1 INTRODUCTION

Food safety plays an important role in the prevention

of foodborne diseases, including diseases caused by

allergens (Fung et al., 2018; Scott, 2003). Hence,

great importance has been given to the production of

agri-food products for dietetic use and the control of

their quality. Among them are "lactose-free" foods.

Their production has increased enormously in recent

years in developed countries (Dekker et al., 2019).

These are products with a lactose content of less than

10mg/kg. Several methods have been used, mainly

citing pre-hydrolysis and post-hydrolysis uring the

production process of these products (Dekker et al.,

2019). This process transforms lactose into glucose

and galactose. These lactose-free foods are used as

part of a lactose-free diet (Suarez et al., 1995;

Ugidos-Rodríguez) . This remains the most effective

tool for the treatment of lactose intolerance.

According to a review and meta-analysis conducted

by and Storhaug al. (2017), the global prevalence

https://orcid.org/0000-0002-3963-1366

https://orcid.org/0000-0003-2166-2903

estimate of lactose malabsorption was 68% (95% CI

64–72), ranging from 28% (19–37) in western,

southern, and northern Europe to 70% (57–83) in the

Middle East. Galactose intolerance is caused by

difficulty or inability to digest lactose due to the

absence or decreased production of the enzyme β-

galactosidase. It is manifested by bloating, gas,

abdominal pain, diarrhea or constipation and

vomiting [7]. Hypolactasia can be congenital as well

as acquired over time. As well, it can be secondary to

an infection with a small bowel disease (celiac

disease, gastroenteritis or Crohn's disease). Its

diagnosis is based primarily on the lactose tolerance

test. This involves measuring blood glucose levels 30

minutes after consumption of lactose diluted in water

(Jansson-Knodell et al., 2020). Following a lactose-

free diet is hindered by several factors. These are

mainly factors related to labelled lactose-free

products. First, patients suffering from lactose

intolerance find it difficult to identify lactose-free

labelled products. Second, their availability is limited.

Third, their price is exorbitant, and finally their

nutritional quality is unbalanced (Świąder et al.,

2020). This, dairy products play an important role in

human nutrition. They are an important source of

minerals, vitamins and proteins. However, their

consumption should be moderate or even

contraindicated for people suffering from lactose

intolerance.

In Morocco, the legislation requires

manufacturers to indicate the allergenic substances on

food labels such as gluten, penault, soya, and milk.

The objective of this law is to avoid the consumption

of substances that can cause effects in people

predisposed such as lactose intolerance. The

production and consumption of dairy products is

increasing considerably (FAO, 2011). At the same

time, gluten intolerance is also on the rise and is

estimated at 73% (Lebiad & Bour, 2016). The use of

the lactose-free diet is also limited by these factors. It

is therefore important to know whether lactose-free

products are available in Morocco?.Also, do patients

suffering from this disease have access to these

products at reasonable prices?.

The objective of the present research is part of this

framework. On the one hand, to identify lactose-free

products in Morocco, and on the other hand, to

evaluate their availability and price in Moroccan

supermarkets and online sales websites.

2 METHODS

This was a cross-sectional study whose objective was

to determine the lactose-free labelled products. The

study was carried out in large Moroccan supermarkets

in the city of Marrakech in Morocco. These

supermarkets are available everywhere in Morocco,

which gives this study a national overview. Other

products have been identified through online sales

sites. A visit was made to each supermarket to

identify the lactose-free products available and

highlight their characteristics. The availability of

products was studied on the one hand by location of

study, and on the other hand by category. The price

of each product was compared to its lactose-

containing equivalent. The price was recorded by the

Moroccan currency (Dirhams) per 1000g/1000ml.

Then it was converted into Euro. Knowing that 1

DMA=0.092 Euro.

The analysis of the results is carried out using the

software SPSS version 25.0 "Statistical Program of

Social Science". The results obtained are expressed as

means and standard deviations or as median and

interquartile range

3 RESULTS AND DISCUSSION

The present research allowed the identification of five

categories lactose-free (LF). These are the category of

LF Milk, LF Yagourt, LF Cheese, Other LF dairy, and

Other LF non-dairy. The various supermarkets make

all these categories available to their customers

suffering from lactose intolerance. On the other hand,

two online sales sites have only one lactose-free

category (figure 1). This is Other LF non-dairy. Only

one online store has three categories. However, the

two categories (LF milk, Other LF dairy) are

represented by only one product each. While 7/9 of

the products belong to the category of Other LF non-

dairy.

Other LF non-dairy are the most represented in the

different points of sale whether it is online sales sites

or in supermarkets. In total, 120 Other LF non-dairy

products are available. Most of the Others LF non-

dairy exists in online sales sites (84/120). However,

the majority of these products are the same and exists

at the in several sites.

Then, LF Yagourt, LF Cheese, and Other LF

dairy are represented by 25, 24 and 19 respectively in

the different points of sale. The category of LF milk

was only by 16 products (figure 2).

Figure 1: Number of category per online site and

Moroccans supermarket

Supermarkets offer a wide range of categories.

However, the number of products remains limited

compared to online sales sites (figure 2).

OnlineA OnlineB OnlineC

SupermarketsA SupermarketsB SupermarketsC

Figure 2: The distribution of number of the lactose-free

products by category and sales site.

Some products can be found in the 6 sales sites.

The exclusion of some products existing in duplicate

has identified 84 different products that exist in

Morocco. It was remarkable that LF Milk was

represented by only 6 products. It includes

pasteurized products and UHT (Ultra Heat Treated)

products. 4 of these products are manufactured by

local companies and two are imported from outside.

The category of LF other dairy was represented by 9

products. These are milk products made mainly from

soy and rice. LF Yagourt and LF Cheese constitute

14.29% and 12% respectively of the total products

identified. While more than half (56%) of the

identified products belong to the Others LF non-dairy

category (figure 3).

The majority of Moroccan supermarkets have

made available to celiac patients areas reserved for

gluten-free products. So, during this research, no

supermarket has reserved an area for lactose-free

products. The latter are dispatched by everything in

the supermarket. The patient suffering from lactose

intolerance has to search all over the supermarket to

collect these products and sometimes he has to travel

from one supermarket to another to collect all the

desired categories.

Figure 3: prevalence of lactose-free products by category

identified

It is remarkable that other dairy and other non-

dairy were 2.9 and 2.5 times more expensive than

their lactose-containing equivalents. This difference

was less in the Yagourt and Cheese categories.

Figure 4 shows the comparison between the prices

of lactose-free products and their gluten-containing

equivalents. In total, lactose-free products are twice

as expensive as regular products with a significant

difference (p˂0.001).

Thus, dairy products labeled "lactose-free"

available in Morocco are rare. Recently, some

Moroccan food companies have recently launched the

1st lactose-free milk in Morocco. However, the

number of companies that have launched this type of

product has not exceeded 2 out of more than 7

companies active in the dairy sector. It is important to

note that even the legislation does not yet require

manufacturers to fortify them, most products have

been enriched with vitamins A and D. The aim is to

develop fresh milk, pasteurized, and UHT milk.

However, lactose-free yagurt, lactose-free cheese is

still predominantly imported from abroad. It will be

enough to choose products with low lactose or

lactose-free or replace it with fortified soy or rice

beverages. According to a study conducted by et al

(Euromonitor Database, 2020), the LF Milk category

is the most responded to.

This research showed the opposite. This category

is the least identified.

Lactose content in cheese products is generally

low. This is due to the production process which

includes a step of washing the curd to lower the

lactose or actin content of the lactic acid bacteria

during ripening (Walstra et al., 1999).

The factors listed below show that patients with

intolerance find it very difficult to follow their

lactose-free diet by accessing lactose-free products.

On the one hand, many patients resort to practices

such as manually adding the industrial lactase enzyme

to dairy products. The effectiveness of this practice is

so difficult as they consume lactase capsules. On the

other hand, many people resort to the replacement of

lactose-free dairy products with other non-dairy

lactose-free products. Les lactases neutres et les

lactases acides sont le type de lactase utilisé. La

première est utilisée par les industriels et est parfois

proposée aux consommateurs pour le traitement du

lait à domicile. The second is used as a nutritional

supplement (Dekker, 2016).

The industry of "gluten-free" products is growing

considerably. There are reserved and indicated

symbols on the labels of these products to identify

these foods, or even foods that are certified as such.

However, there is not yet an international symbol that

allows to know lactose-free foods from their symbol

on their labelling.

Patients suffering from lactose intolerance are

obliged to follow a lactose-free diet. This diet must

include foods that are naturally lactose-free and

products that are labeled lactose-free. Among the

latter, lactose-free dairy products remain essential.

They are an important source of vitamins, calcium,

etc. Therefore, substituting them with other foods can

cause nutritional imbalances. However, it is essential

to take preventive measures especially at the levels of

glucose and galactose since lactose transforms them

(Dekker et al., 2019). Lactose intolerance also

influences the quality of life with a poor score

compared to controls. These patients are faced with a

different food culture from that of society. Access to

food is limited and integration with society becomes

difficult. However, monitoring a lactose-free diet

improves the scores of this quality of life (Zheng et

al., 2015).

In Morocco, the National Food Safety Office

(ONSSA) requires manufacturers to indicate the

allergenic substances on food labels (ONSSA, 2018).

This law requires manufacturers to indicate whether

food allergens such as milk exist in the product.

However, it does not yet require manufacturers to

manufacture enough food for dietary use such as

gluten-free or lactose-free. Hence the need for

Symbol Labelling to encourage manufacturers to do

so. Also, it is important to encourage studies

concerning the determination of exact levels in

naturally lactose-free products and / or foods labeled

lactose-free (Gille et al., 2018; Mangan et al., 16).

This will allow a regular control of these products and

push them to adopt a powerful quality control system

based on the regular application of HACCP (Hazard

Analysis Critical Control Point).

Figure 4: Average price (euro) for lactose-free products and

theirs equivalents products (1000g/1000ml).

4 CONCLUSIONS

Lactose-free products are rare in Morocco. Their

diversification is limited, dominated by the presence

of non-dairy lactose-free products. The price is

expansive and sometimes two to three times more

expensive than regular products. Patients suffering

from gluten intolerance find it very difficult to

identify these products. Hence, the need to encourage

and sensitize food companies, especially those active

in the dairy field, to develop products labeled lactose-

free. At the same time, enrichment with nutrients

remains a necessity in order to avoid any nutritional

deficiency secondary to lactose intoxication.

ACKNOWLEDGEMENTS

Our sincere thanks are addressed to the people in

charge of the supermarkets. Thanks are also

addressed to the dieticians of Mohamed VI University

1,6

2,8

3,2

23,6

0,7

1,7

2,7

1,1

9,3

0,0

5,0

10,0

15,0

20,0

25,0

LF RP

Hospital Center of Marrakech for their advice. Also,

to the patients suffering from lactose intolerance for

highlighting their concerns.

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