Validation in an animal model of the carbon 13–labeled mixed triglyceride breath test for the detection of intestinal fat malabsorption

Kalivianakis, M; Elstrodt, Jm; Havinga, Rick; Kuipers, Folkert; Stellaard, Frans; Sauer, Pieter; Vonk, Roel J.; Verkade, Henkjan J.

doi:10.1016/s0022-3476(99)70166-6

Cited by 26 publications

(22 citation statements)

References 32 publications

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“…The 13 C-SA test would then discriminate whether the lipolytic capacity or, alternatively, the LCFA uptake capability could be identified as the most important contributor to functional development of fat absorption. Because 13 C-SA is already in the form of an absorbable, free fatty acid, its appearance in serum is not expected to be related to intestinal lipolytic activity (39). Except for lipolysis, however, all other processes involved in fatty acid absorption are very similar for 13 C-SA and for (triglyceride-derived) 13 C-PA, both being saturated LCFA.…”

Section: Discussionmentioning

confidence: 99%

“…A theoretical alternative for the use of plasma values would have been the quantitation of the unabsorbed 13 C-fatty acids in the feces. However, the correlation between unabsorbed (fecal) concentrations of 13 C-fatty acids and dietary fat absorption has been demonstrated to be weak, probably attributable to tracer effects and to compensatory 13 C-fatty acid absorption in the distal parts of the small intestine (29,39,(41)(42)(43)(44).…”

Section: Discussionmentioning

confidence: 99%

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Functional Development of Fat Absorption in Term and Preterm Neonates Strongly Correlates with Ability to Absorb Long-Chain Fatty Acids from Intestinal Lumen

Rings

Minich²,

Vonk³

et al. 2002

Pediatr Res

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Our goal for this study was to determine whether the maturation of fat absorption in neonatal life is functionally related to an increased ability to hydrolyze dietary fat, to absorb long-chain fatty acids, or to do both. In 16 preterm and in eight term neonates, the intestinal ability to hydrolyze triacylglycerols and the capacity to absorb long-chain fatty acids were determined at several times between birth and 5 mo after the term age. These processes were compared with the percentage of fat absorption (formula-fed infants) or with fecal fat excretion (breast-fed infants). The functional capacity to digest triacylglycerols and to absorb the lipolytic products was evaluated by measuring serum concentrations of the lipolytic product [1-13 C]palmitate after the enteral administration of tri-1-13 C palmitoyl-glycerol. Longchain fatty acids absorption (i.e. independent of lipolysis) was determined by measuring serum concentrations of [1-13 C]stearate after its enteral administration. The efficacy of fat absorption increased in preterm infants (formula-fed) from 91.2 Ϯ 1.1% (mean Ϯ SEM) at 32. Efficient absorption of fat from the diet is important for energy supply, growth, and development, especially during development (1). At the neonatal age, and particularly in the case of prematurity, a considerable part of dietary fat is not absorbed from the intestine, but is excreted via the feces (2-5). Fat absorption involves digestion, requiring lipolysis by lipolytic enzymes, and the subsequent intestinal absorption of the hydrolyzed fatty acids and monoacylglycerols (6). The uptake of lipolytic products encompasses intraluminal solubilization of lipolytic products, their subsequent translocation across the small intestine, and their incorporation into chylomicrons that are subsequently secreted into the lymph (7). The importance and relative contribution of incomplete digestion and a decreased ability for fatty acid absorption to the causes of increased fecal fat loss during (preterm) infancy is only partly understood. Several studies suggest that lipolysis of fats could be the rate-limiting step in (preterm) neonatal dietary fat absorption. In the human gastrointestinal system several lipases are active on dietary triacylglycerols: gastric lipase (8, 9), pancreatic (colipase-dependent) lipase (10, 11), and bile salt-stimulated lipase (12). Several investigators have demonstrated a decreased intraduodenal concentration of both pan-

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Functional Development of Fat Absorption in Term and Preterm Neonates Strongly Correlates with Ability to Absorb Long-Chain Fatty Acids from Intestinal Lumen

Rings

Minich²,

Vonk³

et al. 2002

Pediatr Res

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“…The results in orlistat-treated rats indicated that significant impairment of fat absorption due to the lipase inhibitor orlistat did not affect the appearance of [ 13 C]palmitic acid in plasma ( Figure 6). Orlistat was used by us and by others previously to generate fat malabsorption in experimental animals (10,32,33). The results of the orlistat experiments point out the specificity of the [ 13 C]palmitic acid absorption test in selectively detecting impaired intestinal uptake of long-chain fatty acids independent of maldigestion of dietary lipids.…”

Section: Figure 4 Mean (± Sem) Plasma Concentrations Of [mentioning

confidence: 99%

“…Several 13 C-labeled fats have been used successfully in the specific detection of impaired lipolysis (6)(7)(8)(9)(10). Attempts to develop a specific test for the detection of impaired uptake of long-chain (unesterified) fatty acids have been less successful, possibly because of methodologic and analytic limitations.…”

Section: Introductionmentioning

confidence: 99%

Detection of impaired intestinal absorption of long-chain fatty acids: validation studies of a novel test in a rat model of fat malabsorption

Kalivianakis¹,

Minich²,

Havinga³

et al. 2000

The American Journal of Clinical Nutrition

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Background: Classic fat balance studies detect fat malabsorption but do not discriminate between the potential causes of malabsorption, such as impaired intestinal lipolysis or reduced uptake of fatty acids. Objective: We aimed to validate a novel test for the specific, sensitive detection of impaired intestinal uptake of long-chain unesterified fatty acids in an appropriate rat model of fat malabsorption. Design: The absorption and appearance in plasma of [13 C]palmitic acid were determined in control rats and in rats with fat malabsorption due either to chronic bile deficiency (permanent bile diversion) or to oral administration of the lipase inhibitor orlistat (200 mg/kg diet). [13 C]Palmitic acid results were compared with the percentage absorption of ingested dietary fat determined by fat balance. Results: Between 1 and 6 h after intraduodenal administration, plasma [ 13 C]palmitate concentrations in control rats were 4-10-fold higher than in bile-deficient rats (P < 0.05) but were not significantly different between orlistat-supplemented rats and their controls. In control and bile-deficient rats, plasma [13 C]palmitate concentrations allowed complete discrimination between normal (> 92%) and reduced (< 92%) fat absorption, whereas the percentage absorption of [ 13 C]palmitate over 48 h appeared to be highly correlated with the percentage absorption of ingested dietary fat (r = 0.89, P < 0.001). Conclusions: The [13 C]palmitic acid absorption test detects impaired intestinal absorption of long-chain fatty acids selectively and sensitively in a rat model of fat malabsorption due to bile deficiency. Our data strongly support the use of the

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“…This report found that the test has a sensitivity of 89% and a specificity of 81%. The 13 C-MTG breath test as a marker of lipase activity correlates well with other measuring techniques [1,6,11,17]. It is suitable for children, easy to perform, and has less likelihood for error than the 3-day fecal fat test [9].…”

Section: Introductionmentioning

confidence: 99%

Estimation of postoperative fat absorption using the 13C mixed-triglyceride breath test in children with choledochal cyst

et al. 2008

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No previous studies have focused on postoperative fat malabsorption in children with choledochal cyst (CC) who undergo cyst excision and Roux-en-Y (RY) hepatico-jejunostomy (HJ), a combination of procedures that can lead to the non-physiological mixture of food and bile juice. To examine the effect of RYHJ with cholecystectomy on the fat absorption ability of children with CC, we estimated postoperative fat-absorption ability using the carbon 13-labeled mixed triglyceride (13C-MTG) breath test. Twelve postoperative children with CC and 12 normal control children were administered 13C-MTG orally and asked to give breath samples at six time points: once before the 13C-MTG ingestion and at five 60-min intervals postingestion. Fecal chymotrypsin activity and fecal fat excretion were also measured. The delta value of breath 13CO2 at 3, 4, and 5 h after administration and the 5-h cumulative breath 13CO2 were significantly lower in the CC children than in the controls. There were no significant differences in the fecal chymotrypsin activity or fecal fat excretion of the two groups. Conclusion. Occult fat malabsorption occurs in patients with CC after RYHJ, even in the absence of clinical symptoms or abnormal laboratory data.

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Validation in an animal model of the carbon 13–labeled mixed triglyceride breath test for the detection of intestinal fat malabsorption

Cited by 26 publications

References 32 publications

Functional Development of Fat Absorption in Term and Preterm Neonates Strongly Correlates with Ability to Absorb Long-Chain Fatty Acids from Intestinal Lumen

Functional Development of Fat Absorption in Term and Preterm Neonates Strongly Correlates with Ability to Absorb Long-Chain Fatty Acids from Intestinal Lumen

Detection of impaired intestinal absorption of long-chain fatty acids: validation studies of a novel test in a rat model of fat malabsorption

Estimation of postoperative fat absorption using the 13C mixed-triglyceride breath test in children with choledochal cyst

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