triolein and Malabsorption-Syndromes

Topics: Child; Child, Preschool; Cobalt Radioisotopes; Diet Therapy; Glucose; Glucose Tolerance Test; Guatemala; Humans; Infant; Infant Nutritional Physiological Phenomena; Intestinal Absorption; Iodine Radioisotopes; Lipid Metabolism; Malabsorption Syndromes; Nitrogen; Oleic Acids; Protein-Energy Malnutrition; Triolein; Vitamin A; Vitamin B 12; Xylose

A simple non-invasive test not requiring the use of radioactive isotopes is required to assess fat malabsorption in adult cystic fibrosis (CF) patients. Breath tests using substrates labeled with 13C meet these conditions. The 14C-triolein breath test is sensitive and specific for measuring fat malabsorption, but involves radiation exposure. The aim of this study was to examine the utility of a test using a 13C label and to determine whether pancreatic replacement therapy would return the test to the values of a normal control group.. 13CO2 recovery was assessed after an overnight fast in six adult patients with CF, both with and without pancreatic enzyme replacement therapy (PERT) in the usual dose for a light snack, in a randomized order, on different days. Studies were also performed in eight healthy volunteers after oral ingestion. Subjects drank 50 mL of a liquid meal mixed with 200 microL 13C-triolein and breath samples were collected by blowing through a straw into collection tubes every 30 min for 6 h. The effect of gastric emptying was assessed by comparison of oral ingestion with intraduodenal infusion. Intra-individual variability was assessed in nine volunteers by repeating the breath test after drinking the test meal on a separate day.. Compared with healthy subjects there was virtually no recovery of 13CO2 in CF patients without PERT. The median (interquartile range) cumulative percentage dose recovery (cPDR) at 6 h was 3% (0-8) in CF patients compared with 28% (22-41) in healthy controls (P < 0.01). Fat absorption was normalized (37%) (36-43) after ingestion of PERT. Gastric emptying delayed the peak in 13CO2 recovery, but there was no difference in the cPDR at 6 h. There was no difference in recovery between days 1 and 2.. The 13C-triolein breath test is a simple and reproducible method to measure fat malabsorption. The test provides a screening technique for fat malabsorption in adult CF patients and may be useful for monitoring the lowest effective dose of PERT.

Topics: Administration, Oral; Adult; Breath Tests; Carbon Isotopes; Cross-Over Studies; Cystic Fibrosis; Dietary Fats; Duodenum; Enzyme Therapy; Female; Gastric Emptying; Humans; Malabsorption Syndromes; Male; Middle Aged; Pancreas; Triolein

Somatostatin and its long-acting analogue SMS 201-995 (Sandostatin) have been suspected of causing steatorrhoea. The aim of this study was to examine the effect of SMS 201-995 on fat assimilation in healthy subjects, using 14C-triolein and 3H-oleic acid as tracers of dietary triglycerides and free fatty acids, respectively, and 51CrCl3 as non-absorbable marker. Six healthy male volunteers participated in the double-blinded, randomized, crossover study. In each test period either 1 ml of SMS 201-995, containing 200 micrograms, or 1 ml of isotone saline was given subcutaneously three times within 16 h. Faeces were collected for 3 days, every stool separately. The faecal 14C-triolein and 3H-oleic acid excretion was calculated from two aliquots of faeces. In addition, the mean daily faecal fat excretion was estimated. When placebo was given, the median 14C-triolein excretion was 1% (range, 0.9-1.6%), the median 3H-oleic acid excretion was 5% (range, 3-10%), and the daily faecal fat excretion was 4 g/day (range, 1-6 g/day), all within normal limits. When SMS 201-995 was given, the faecal 14C-triolein excretion increased to a median of 75% (range, 43-119%), the 3H-oleic acid excretion increased to a median of 82% (range, 46-126%), and the faecal fat excretion increased to a median of 22 g/day (range, 4-34 g/day), all clearly above normal. The faecal 14C-triolein/3H-oleic acid test showed triglycerides and free fatty acids to be equally malassimilated, which indicates malabsorption.

Topics: Adult; Dietary Fats; Double-Blind Method; Feces; Humans; Lipids; Malabsorption Syndromes; Male; Octreotide; Oleic Acids; Randomized Controlled Trials as Topic; Triolein

The carbon-14-triolein absorption test was used to investigate fat absorption and its response to pancreatic enzyme replacement therapy in 10 men with pancreatic steatorrhoea. Absorption was increased in all, from 1,14 +/- 1,2% of the dose per hour (group mean +/- SD) to 2,85 +/- 2,33% (P less than 0,01) by the simultaneous administration of 8 tablets of enteric-coated pancreatic enzymes (Nutrizym; Merck). In patients with normal or high gastric acid secretion, neutralization of gastric acid with 30 ml magnesium trisilicate had no effect on absorption while the addition of an extract of gastric secretions (Enzynorm; Noristan) to the therapy of the 1 achlorhydric patient improved absorption from 2,2% to 3,81%. The 14C fat test offers a rapid and more acceptable alternative method for determining individual response to pancreatic enzyme replacement therapy than the conventional 72-hour faecal fat excretion measurement. The enteric-coated pancreatin preparation used in this study appears to be optimally effective under conditions of normal gastric acid secretion.

Topics: Adult; Amylases; Bromelains; Carbon Radioisotopes; Clinical Trials as Topic; Drug Combinations; Evaluation Studies as Topic; Gastric Acid; Humans; Intestinal Absorption; Lipase; Malabsorption Syndromes; Male; Pancreatic Diseases; Tablets, Enteric-Coated; Triolein; Trypsin

The glycerol tri[1-14C]olein test for fat malabsorption was carried out in two male volunteers and measurements of the loss of 14C in expired air, urine and faeces and the retention of 14C in biopsy samples of abdominal fat were made using accelerator mass spectrometry. Exhalation accounted for 73% and 55% of the administered activity and could be described by three-component exponential functions with halftimes of about 1h, 2 days and 150 days, respectively. Urinary excretion accounted for 24% of the administered activity, almost all during the first 24h after administration; about 2% was excreted in the faeces in 48h. The halftime of retention of 14C in fat ranged from 137 to 620 days. Absorbed dose calculations indicate that for a normal adult the largest dose, 1.5-7.0mGy/MBq is received by the adipose tissue, and that the effective dose is 0.3-0.5mSv/MBq. It is concluded that no restrictions need to be placed on radiation safety grounds on the administration of 0.05-0.1MBq 14C-triolein for the triolein breath test.

Topics: Adipose Tissue; Adult; Biopsy, Needle; Breath Tests; Carbon Dioxide; Carbon Radioisotopes; Dietary Fats; Feces; Half-Life; Humans; Malabsorption Syndromes; Male; Middle Aged; Radiation Dosage; Radionuclide Imaging; Tissue Distribution; Triolein

Essential fatty acid (EFA) deficiency induces fat malabsorption, but the pathophysiological mechanism is unknown. Bile salts (BS) and EFA-rich biliary phospholipids affect dietary fat solubilization and chylomicron formation, respectively. We investigated whether altered biliary BS and/or phospholipid secretion mediate EFA deficiency-induced fat malabsorption in mice. Free virus breed (FVB) mice received EFA-containing (EFA(+)) or EFA-deficient (EFA(-)) chow for 8 wk. Subsequently, fat absorption, bile flow, and bile composition were determined. Identical dietary experiments were performed in multidrug resistance gene-2-deficient [Mdr2((-/-))] mice, secreting phospholipid-free bile. After 8 wk, EFA(-)-fed wild-type [Mdr2((+/+))] and Mdr2((-/-)) mice were markedly EFA deficient [plasma triene (20:3n-9)-to-tetraene (20:4n-6) ratio >0.2]. Fat absorption decreased (70.1 +/- 4.2 vs. 99.1 +/- 0.3%, P < 0.001), but bile flow and biliary BS secretion increased in EFA(-) mice compared with EFA(+) controls (4.87 +/- 0.36 vs. 2.87 +/- 0.29 microl x min(-1) x 100 g body wt(-1), P < 0.001, and 252 +/- 30 vs. 145 +/- 20 nmol x min(-1) x 100 g body wt(-1), P < 0.001, respectively). BS composition was similar in EFA(+)- and EFA(-)-fed mice. Similar to EFA(-) Mdr2((+/+)) mice, EFA(-) Mdr2((-/-)) mice developed fat malabsorption associated with twofold increase in bile flow and BS secretion. Fat malabsorption in EFA(-) mice is not due to impaired biliary BS or phospholipid secretion. We hypothesize that EFA deficiency affects intracellular processing of dietary fat by enterocytes.

Topics: Animals; ATP Binding Cassette Transporter, Subfamily B; ATP-Binding Cassette Transporters; Bile; Bile Acids and Salts; Body Weight; Carbon Radioisotopes; Cholestanetriol 26-Monooxygenase; Cholesterol 7-alpha-Hydroxylase; Cytochrome P-450 Enzyme System; Dietary Fats; Diterpenes; Enterocytes; Fatty Acids; Fatty Acids, Essential; Homozygote; Kinetics; Liver; Malabsorption Syndromes; Mice; Mice, Knockout; Oleic Acid; Phospholipids; Polyethylene Glycols; Retinyl Esters; RNA, Messenger; Steroid Hydroxylases; Triolein; Tritium; Vitamin A

The aim of this study was to evaluate fat absorption in HIV-positive (HIV+) patients in different phases of HIV infection using a 14C-triolein breath test. We distributed 47 HIV+ patients according to the 1993 Centers for Disease Control Revised Classification: 20 in Group 2 (A1 or A2) and 27 in Group 3 (B1, B2, A3, B3, or C). Ten HIV-negative healthy subjects comprised the control group (Group 1). All individuals underwent a 14C-triolein breath test. Parasitic infection was evaluated through three stool exams, including Cryptosporidium and Isospora investigation. The median value of cumulative 6 hours' 14C excretion expressed as percentage of the 14C given as triolein was significantly higher in Group 1 (8.4%) than Group 2 (5.5%) or Group 3 (3.4%), p = 0.04 and p << 0.01, respectively. Fat malabsorption was found in 25% of Group 2 individuals, 52.6% of those without diarrhea in Group 3, and was correlated with CD4+ lymphocyte counts (p << 0.01). Fat malabsorption is a common feature in advanced stages of HIV infection, even in the absence of diarrhea and is also present in asymptomatic HIV+ patients. These findings suggest that malabsorption is an early event in HIV-infected individuals and is correlated with the degree of immunosuppression.

Topics: Adult; Breath Tests; Carbon Radioisotopes; Case-Control Studies; CD4 Lymphocyte Count; Fats; Female; HIV Infections; HIV Seropositivity; Humans; Malabsorption Syndromes; Male; Parasitic Diseases; Time Factors; Triolein

A novel fat absorption test to clarify the malabsorption syndrome was developed using a micronephelometric technique and compared with the classic conventional technique using 131I-triolein. An integrity of time-sequential light scattered from chylomicron-related turbidity in serum was determined between 0 and 300 min after butter fat load, being expressed in terms of the light scattering intensity (LSI). A good correlation was obtained between LSI and the serum level of chylomicron-triglyceride determined by an ultracentrifugation technique (r = 0.819, P < 0.001). The maximal LSI was consistently observed at 180 min after administration of a test meal in the normal group (n = 39), whereas the malabsorption syndrome group (n = 35) was distinctly different and could be further classified according to four patterns of LSI changes. In addition, an inverse correlation was found between this fat absorption test and the 131I-triolein absorption test. It was concluded that the micronephelometric technique which does not use a radionuclide is advantageous in its simple and safe evaluation of fat malabsorption syndrome.

Topics: Adult; Butter; Chemistry Techniques, Analytical; Chylomicrons; Dietary Fats; Female; Humans; Iodine Radioisotopes; Light; Lipoproteins; Malabsorption Syndromes; Male; Microscopy, Electron; Middle Aged; Triglycerides; Triolein

Malnutrition resulting from chronic congestive heart failure (cardiac cachexia, CC) is not uncommon and contributes to mortality and morbidity especially of elderly people. The aetiology of cardiac cachexia is probably multifactorial. We have assessed whether malabsorption of fat is associated with CC and if so whether it is due to small-bowel bacterial overgrowth. Three groups of subjects were studied: 29 (20 women) patients (mean age 76.1 years) with controlled congestive heart failure and weight loss (CC); 14 (seven women) patients (mean age 74.0 years) with controlled congestive heart failure and no weight loss (non-cachexia, NON-CC); and 29 (20 women) healthy controls (mean age 74.9 years). Fast absorption was quantified using the cumulative 6 h 14CO2 exhalation in the 14C-triolein breath test and small-bowel bacterial overgrowth was quantified using the cumulative 8 h 14CO2 exhalation in the 14C-glycocholic acid breath test. The cumulative 6 h 14CO2 exhalation in the triolein breath test was reduced in the CC group (p = 0.001) implying impaired fat absorption. There was no evidence of small-bowel bacterial overgrowth in any group. Impaired absorption of fat was related to the clinical severity of heart failure and its duration. Impaired fat absorption is associated with cardiac cachexia. It is not due to small-bowel bacterial overgrowth. The aetiology of fat malabsorption in heart failure requires further studies.

Topics: Aged; Aged, 80 and over; Breath Tests; Cachexia; Dietary Fats; Female; Glycocholic Acid; Heart Failure; Humans; Intestinal Absorption; Intestinal Mucosa; Malabsorption Syndromes; Male; Triolein; Weight Loss

Patients being investigated for intestinal absorptive capacity were classified as normals or malabsorbers on the basis of three fat absorption tests. Malabsorbers were further classified as mild, moderate, severe or gross according to severity of malabsorption. Using this classification system the triolein breath test was evaluated in 53 patients. Seventeen patients were excluded because their graph of percentage breath [14C]carbon dioxide versus time was exponential indicating that the peak [14C]-carbon dioxide may be occurring later than the six hour duration of the test. The sensitivity and specificity of the triolein breath test were found to be 100% and 96%, respectively and moderate correlations with the individual fat absorption tests were found. However, the breath test was limited in its capacity to predict the severity of malabsorption. Carbon dioxide output was also measured in order to determine the applicability of using an assumed value. The respiratory quotient and variability of results were high in nineteen patients indicating possible hyperventilation. In 32 patients with reproducible results and normal respiratory quotients the average carbon dioxide output was 8.66 mmol/kg per hour with a wide range of 5-12.4 mmol/kg per hour. Consequently the use of an assumed carbon dioxide output can introduce considerable errors in the triolein breath test. This study highlights drawbacks of the triolein breath test, particularly problems in using an assumed carbon dioxide output for its calculation, its inability to predict the severity of malabsorption and the nature of the dietary load used.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Breath Tests; Carbon Dioxide; Carbon Radioisotopes; Child; Chromium Radioisotopes; Fats; Feces; Humans; Intestinal Absorption; Malabsorption Syndromes; Metabolic Diseases; Middle Aged; Respiration Disorders; Triolein; Tritium

The 14C-triolein breath test, a recognised index of fat absorption, and the p-aminobenzoic acid (PABA) test, a 'tubeless' test of exocrine pancreatic function, have both been widely used in the diagnosis of malabsorption and exocrine pancreatic insufficiency. This study evaluates the potential of a combination of both tests in the investigation of fat absorption and exocrine pancreatic function. Combination of the tests has become technically feasible because of the introduction of high pressure liquid chromatography as the preferred method of analysis for PABA, and use of p-aminosalicylic acid (PAS) as the marker for PABA absorption and metabolism. We studied 25 healthy subjects, 11 patients with exocrine pancreatic disease and 12 patients with gastrointestinal disease. The combined test identified subjects with reduced fat absorption and distinguished subjects with exocrine pancreatic insufficiency from those with an intestinal cause of fat malabsorption. The test could be completed in 7 h and had high patient acceptability. These findings suggest that the combined 14C-triolein breath test and PABA test can be used as a non-invasive, 1-day investigation of fat absorption and exocrine pancreatic function.

Topics: 4-Aminobenzoic Acid; Adult; Aged; Aminosalicylic Acid; Breath Tests; Carbon Dioxide; Diarrhea; Dietary Fats; Female; Gastrointestinal Diseases; Humans; Intestinal Absorption; Malabsorption Syndromes; Male; Middle Aged; Pancreatic Diseases; Triolein

Malnutrition in patients with acquired immune deficiency syndrome (AIDS) is common and multifactorial. The possible causes of malnutrition were evaluated by performing studies of energy balance in five clinically stable outpatients with AIDS, six seronegative homosexual control subjects, and five seronegative heterosexual control subjects. The AIDS group was significantly depleted of body cell mass compared with the control subjects but the values did not change significantly over 6 wk. Food intake was normal in the AIDS group whereas intestinal absorptions of the pentose sugar xylose and of the triglyceride triolein were both significantly diminished. The AIDS patients were hypometabolic as compared with the control subjects and with predictions of metabolic rate based on the Harris-Benedict equation. We conclude that short-term energy balance can be maintained in clinically stable patients with AIDS. Hypometabolism is an appropriate metabolic response to the combination of body-cell-mass depletion and nutrient malabsorption.

Topics: Acquired Immunodeficiency Syndrome; Adult; Basal Metabolism; Body Composition; Body Mass Index; Eating; Energy Metabolism; Humans; Intestinal Absorption; Malabsorption Syndromes; Male; Nutrition Disorders; Potassium; Prospective Studies; Triolein; Xylose

The feasibility of using the triolein breath test to demonstrate fat malabsorption was evaluated in a prospective study of patients before and after total gastrectomy and Roux-en-Y reconstruction. Two of 11 patients had subnormal fat absorption before the operation, but 1 and 6 months after the operation 9 of 11 patients had subnormal fat absorption. Peak expiratory 14CO2 (median (range] at the three investigations was 3.9%/h (2.1-5.9%/h), 2.1%/h (1.4-4.5%/h), and 2.0%/h (1.2-6.0%/h), respectively. Patients who underwent a Nissen fundoplication were used as controls. They had normal fat absorption both before and after operation. Serum amylase was not appreciably affected by total gastrectomy and was similar to control values. In contrast, serum albumin decreased 1 month after gastrectomy and recovered after 6 months. In control patients pre- and post-operative albumin concentrations did not differ and were comparable to preoperative albumin values in the total gastrectomy group. The lowered fat absorption may be explained by duodenal bypass with decreased pancreatic stimulation, and it may in part explain the weight loss in patients operated on with total gastrectomy.

Topics: Aged; Anastomosis, Roux-en-Y; Breath Tests; Dietary Fats; Female; Follow-Up Studies; Gastrectomy; Humans; Malabsorption Syndromes; Male; Middle Aged; Prospective Studies; Stomach Neoplasms; Triolein

Topics: Carbon Radioisotopes; Digestion; Digestive System; Humans; Intestinal Absorption; Iodine Radioisotopes; Malabsorption Syndromes; Triolein

We have compared the [14C]triolein breath test for fat malabsorption with fecal fat excretion corrected for marker pellet recovery in 23 subjects with chronic liver disease. The breath test identified 15 of the 17 subjects with abnormal fecal fat excretion (sensitivity 88%). However, four of the six subjects with normal fecal fat excretion gave abnormal breath test results (specificity 33%). While three of the four subjects with falsely abnormal breath tests had alcoholic liver disease, the explanation for the low specificity is unclear and may not be confined to patients with alcohol-related disease. We are therefore unable to recommend the breath test as a screen for steatorrhea in patients with chronic liver disease.

Topics: Breath Tests; Chronic Disease; Dietary Fats; False Negative Reactions; False Positive Reactions; Feces; Female; Humans; Intestinal Absorption; Liver Diseases; Malabsorption Syndromes; Male; Triolein

The [14C]-triolein absorption test has been assessed using a preprepared fat meal in a procedure that can be completed within a working day on an inpatient or outpatient basis. An initial study showed complete discrimination between 30 control subjects and 13 patients with raised faecal fat excretion. A prospective evaluation in 57 patients under investigation for gastrointestinal disease showed a sensitivity of 85% and specificity of 93% (100% if two obese subjects are excluded). The test discriminates satisfactorily between patients with and without fat malabsorption and makes the measurement of faecal fat unnecessary in most circumstances.

Topics: Adult; Aged; Aged, 80 and over; Carbon Radioisotopes; Celiac Disease; Dietary Fats; Feces; Humans; Intestinal Absorption; Malabsorption Syndromes; Middle Aged; Prospective Studies; Triolein

[14C]Triolein and [3H]oleic acid are useful tracers of dietary triglycerides and free fatty acids. The combustion/liquid scintillation counting technique was found a practicable method of estimating the fecal activity of these tracers. When ingested with the nonabsorbable marker 51CrCl3, the fecal excretion of 14C and 3H could be estimated accurately from samples of two stools. This technique was investigated as a test of lipid assimilation in a prospective, blind study of 84 consecutive patients suspected of malassimilation. The fecal excretion of 14C was a useful alternative to fecal fat: the patients with "normal lipid assimilation" excreted less than or equal to 10.4% of the dose ingested, whereas 25 of the 26 patients with steatorrhea ("unequivocal malassimilation") excreted greater than 10.4%. Fecal fat was normal in 18 patients who exhibited other signs of malassimilation ("equivocal malassimilation"); in 5 of these patients fecal excretion of 14C was greater than 10.4%. Lastly, there was a significant correlation between fecal 14C and fecal fat (r = 0.82, p less than 0.001). The fecal 14C/3H ratio was found useful as an index of pancreatic digestive function, being less than 1.3 in patients with "normal" lipid digestion and greater than or equal to 1.3 in 18 of the 19 patients with pancreatic steatorrhea and in 19 of the 27 patients with severely reduced exocrine pancreatic function. The test result was found widely independent either of the amount of carrier fat or the quality of the fecal collections and was therefore useful as an outpatient test. As it provided information about the pathogenesis of malassimilation and was at least as sensitive and specific as a fat "balance study," the test may be a useful alternative to fecal fat measurement.

Topics: Carbon Radioisotopes; Dietary Fats; Feces; Humans; Intestinal Absorption; Lipid Metabolism; Lipids; Malabsorption Syndromes; Oleic Acids; Pancreatic Function Tests; Prospective Studies; Triolein; Tritium

In 125 consecutive patients the measurement of serum radioactivities after simultaneous ingestion of 14C-triolein and 3H-oleic acid was investigated as a test of lipid assimilation. The sum of the 2-h and 4-h concentrations of 14C in serum (se(2 + 4)14C) was most useful as an index of lipid assimilation, and the 2-h serum 3H/14C ratio (se-3H/14C) reflected lipid digestion. Normal values were se(2 + 4)14C greater than or equal to 1.0% of the dose ingested per litre serum and se-3H/14C less than 1.3. Se(2 + 4)14C correlated significantly with faecal fat (r = -0.56, P less than 0.001) and indicated malassimilation in 26 of the 50 patients with a faecal fat excretion greater than 7 g/day. False-negative values appeared mainly in the patients with moderate steatorrhoea and gastrointestinal anastomoses. Only one false-positive se(2 + 4)14C value was found. Se-3H/14C was abnormal in 24 of the 34 patients with maldigestion with 2 false-positive results. When the results of se(2 + 4)14C and se-3H/14C were combined, the predictive value of the test result 'normal lipid assimilation' was 0.75, that of the test result 'maldigestion' was 0.93, and that of 'malabsorption' was 0.71. It is concluded that the serum 14C-triolein/3H-oleic acid assimilation test is convenient and inexpensive and may be useful when quantitative faecal collections are not available.

Topics: Adult; Aged; Diagnosis, Differential; Digestion; Female; Food; Humans; Intestinal Diseases; Lipid Metabolism; Malabsorption Syndromes; Male; Middle Aged; Oleic Acid; Oleic Acids; Radioisotopes; Triolein

Twenty-two hospital patients without gastrointestinal symptoms and fourteen patients with clinically suspected fat malabsorption were studied using the 14C-Triolein Breath Test and three day fecal fat estimation. The 14C-Triolein Breath Test was 100% sensitive and 86% specific for fat malabsorption. Three day fecal fat estimations were 86% sensitive and 91% specific. These data confirm the high sensitivity and specificity obtained using the 14C-Triolein Breath Test. The speed and convenience of the 14C-Triolein Breath Test plus acceptable sensitivity and specificity make this a practical screening test to detect fat malabsorption.

Topics: Adult; Aged; Breath Tests; Carbon Radioisotopes; Evaluation Studies as Topic; Female; Humans; Lipid Metabolism; Malabsorption Syndromes; Male; Middle Aged; Triolein

The ratio between assimilation of simultaneously ingested 14C-triolein and 3H-oleic acid was investigated as a test of pancreatic digestive function in 48 consecutive patients suspected of malassimilation. Faecal excretion of 14C-triolein and 3H-oleic acid was measured by means of a combustion/liquid scintillation counting technique. Compared with the patients in whom the clinical investigation showed normal lipid assimilation (no. = 31) the assimilation of both 14C-triolein and 3H-oleic acid was significantly reduced in the patients with malabsorption (no. = 6) and maldigestion (no. = 11). However, in all except one patient with maldigestion the assimilation of 14C-triolein was more reduced than that of 3H-oleic acid, whereas there was no difference in 14C-triolein and 3H-oleic acid assimilation in the patients with malabsorption and normal lipid assimilation. Measurement of the postprandial serum radioactivities of 14C and 3H, like the faecal measurements, indicated more severely reduced assimilation of 14C-triolein than of 3H-oleic acid in the patients with maldigestion than in the other patient groups. In fact, the 2-h postprandial 3H/14C ratio at a level of 1.3 correctly classified digestive function in 47 of the 48 patients.

Topics: Digestion; Feces; Humans; Intestinal Absorption; Malabsorption Syndromes; Oleic Acids; Pancreatic Function Tests; Pancreatitis; Scintillation Counting; Triolein

In an attempt to establish a test of lipid assimilation, based on the measurement of the postprandial serum radioactivity of 14C from ingested 14C-triolein, the activity of 14C was measured in serum samples, drawn 1,2,3,4,6 and 9 h after ingestion in 48 consecutive patients suspected of malassimilation. Simultaneously, faecal excretion of 14C was measured to estimate 14C-triolein assimilation (F-14C-Ass). F-14C-Ass served as reference of 14C-triolein assimilation. The sum of the 2- and 4-h serum concentration of 14C (S-(2 + 4)14C) was found to be most useful as an estimate of 14C-triolein assimilation, with regard to both the diagnostic value and applicability. At a level of 1.0% of dose/l serum, S-(2 + 4)14C correctly discriminated between normal and reduced 14C-triolein assimilation in 83% of the patients (95% confidence limits 70-93%). A significant correlation between 14C-triolein assimilation and S-(2 + 4)14C was found (r = 0.91, P less than 0.001). Since 14C-triolein assimilation correlates closely with the assimilation of dietary lipids, S-(2 + 4)14C seems to provide in a simple way sufficient information about lipid assimilation to be useful as a clinical test.

Topics: Carbon Radioisotopes; Feces; Food; Humans; Malabsorption Syndromes; Triolein

Two tests of lipid assimilation based on estimation of 14C-triolein assimilation from expiratory 14CO2 (breath test) and from serum radioactivity of 14C, respectively, were investigated in 48 consecutive patients suspected of having malassimilation. Patients with proven malassimilation had significantly lower expiration of 14CO2 and lower serum radioactivity of 14C than patients with normal lipid assimilation. The se-14C test correctly diagnosed significantly more patients with malassimilation than the breath test; the diagnostic efficiencies were 0.87 and 0.74, respectively. The results of both tests correlated with measurement of faecal fat. However, within the group of patients with proven malassimilation the results of the breath test correlated poorly with faecal fat, whereas a significant correlation was found between the se-14C test and faecal fat within this group. Correspondingly, the correlation between the results of the breath test and the se-14C test was poor, indicating that intermediate metabolism influences the results.

Topics: Adult; Aged; Breath Tests; Carbon Dioxide; Carbon Radioisotopes; Celiac Disease; Female; Humans; Malabsorption Syndromes; Male; Middle Aged; Triolein

In 24 patients with malabsorption, [14C]triolein breath tests were conducted before and together with the administration of pancreatic enzymes (Pancrease, Johnson and Johnson, Skillman, N.J.). Eleven patients with pancreatic insufficiency had a significant rise in peak percent dose per hour 14CO2 excretion after Pancrease, whereas 13 patients with other causes of malabsorption had no increase in 14CO2 excretion (2.61 +/- 0.96 vs. 0.15 +/- 0.45, p less than 0.001). The two-stage [14C]triolein breath test appears to be an accurate and simple noninvasive test of fat malabsorption that differentiates steatorrhea secondary to pancreatic insufficiency from other causes of steatorrhea.

Topics: Breath Tests; Carbon Radioisotopes; Celiac Disease; Diagnosis, Differential; Exocrine Pancreatic Insufficiency; Humans; Malabsorption Syndromes; Pancreatin; Triolein

Topics: Breath Tests; Chronic Disease; Humans; Malabsorption Syndromes; Pancreas; Pancreatic Function Tests; Pancreatitis; Triolein

It is important to understand which pancreatic function tests are available and how to interpret them when evaluating patients with malabsorption. Available direct tests are the secretin stimulation test, the Lundh test meal, and measurement of serum or fecal enzymes. Indirect tests assess pancreatic exocrine function by measuring the effect of pancreatic secretion on various nutrients. These include triglycerides labeled with carbon 14, cobalamin labeled with cobalt 57 and cobalt 58, and para-aminobenzoic acid bound to a dipeptide. Of all these tests the secretin stimulation test is the most accurate and reliable if done by experienced personnel. However, the indirect tests are simpler to do and appear to be comparable to the secretin test at detecting pancreatic exocrine insufficiency. These indirect tests are becoming clinically available and clinicians should familiarize themselves with the strengths and weaknesses of each.

Topics: 4-Aminobenzoic Acid; Amylases; Carbon Radioisotopes; Exocrine Pancreatic Insufficiency; Fats; Feces; Humans; Intrinsic Factor; Lipase; Malabsorption Syndromes; Pancreas; Pancreatic Function Tests; Pancreatin; Secretin; Triolein; Vitamin B 12

To differentiate maldigestion from malabsorption of fat, we compared the radioactivity of triglyceride with non-esterified fatty acid in fecal fat after ingestion of radiochemically purified 131I-triolein. A large amount of radioactivity was present in the triglyceride fraction from patients with pancreatic insufficiency, while such was found only in non-esterified fatty acid fraction in patients with short bowel syndrome, as determined by thin-layer chromatogram scanning. Thus, the "Digestion-Absorption Index" was calculated as a ratio of the radioactivity of triglyceride to that of non-esterified fatty acid. Mean Digestion-Absorption Index was 0.946 in the maldigestive group, and 0.045 in the malabsorptive group, and there was a statistical significance. However, an overlap in a few cases was confirmed in the area of 0.10 +/- 0.02, when this index was plotted on a table of semilogarithms. We assumed that this overlap was chiefly the result of maldigestion plus malasorption of fat.

Topics: Adult; Aged; Autoradiography; Chromatography, Thin Layer; Diagnosis, Differential; Dietary Fats; Digestion; Digestive System Diseases; Fatty Acids, Nonesterified; Feces; Humans; Intestinal Absorption; Iodine Radioisotopes; Lipid Metabolism; Malabsorption Syndromes; Middle Aged; Triglycerides; Triolein

Topics: Breath Tests; Carbon Radioisotopes; Dietary Fats; Feces; Humans; Malabsorption Syndromes; Triolein

Topics: Breath Tests; Humans; Malabsorption Syndromes; Triolein

Topics: Humans; Intestinal Absorption; Iodine Radioisotopes; Malabsorption Syndromes; Oleic Acids; Triolein

A double-tracer technique to estimate lipid digestion was investigated. 3H-labelled oleic acid and 14C-labelled triolein were ingested in a test meal. The serum radioactivity of 3H after ingestion of labelled oleic acid depends on absorption and metabolism of free fatty acids, while serum radioactivity of 14C from triolein, in addition to the former, depends on triglycerol digestion. This study shows that the ratio between 3H and 14C 2h after the test meal gives a good qualitative and quantitative estimation of lipid digestion: the 3H/14C ratio in patients with maldigestion is significantly higher than for normals (P less than 0.01), the predictive value of the 3H/14C ratio in the diagnosis of maldigestion is high, that of a positive result being 1.0 and that of a negative 0.93, and quantitatively the 3H/14C ratio shows a highly significant correlation with faecal fat (P less than 0.001). The test is very easy to perform, lasts for only 2 h, and is without discomfort to the patient or nursing and laboratory staff. It gives information like or superior to that of faecal fat measurement.

Topics: Adult; Aged; Celiac Disease; Dietary Fats; Feces; Female; Humans; Malabsorption Syndromes; Male; Middle Aged; Oleic Acids; Pancreatic Juice; Pancreatic Neoplasms; Pancreatitis; Triolein

Topics: Adolescent; Adult; Child; Female; Humans; Intestinal Absorption; Intestine, Small; Jejunum; Lipid Metabolism; Malabsorption Syndromes; Male; Middle Aged; Oleic Acids; Schistosomiasis; Triolein

Topics: Dietary Fats; Humans; Malabsorption Syndromes; Postgastrectomy Syndromes; Time Factors; Triolein; Vagotomy

The possibility that the unreliability of urinary excretion of radioactivity after the administration of oral 131I-triolein, as a measure of fat absorption, is due to variable renal clearance of iodide prompted investigation of a double-radioisotopic method. Intravenously administered radioiodide should be cleared identically with radioiodide split from absorbed fat and serve as an internal standard. Oral 131I-triolein was given in an 80 gm fat liquid meal; 125I-iodide was given intravenously; urine was collected fractionally for 72 hr. Accepted stool fat excretion data and stool radioactivity excretion data developed in this study were used to define groups of normals (less than 5.4 gm of fat or less than 7.8% 131I) and malabsorbers (greater than 5.4 gm of fat or greater than 7.8% 131I). In 26 normals urinary 131I ranged from 24.6% to 77.1% in 48 hr and 27.7% to 86.8% in 72 hr; in the malabsorbers these values lay between 0.6% and 62.8% in 48 hr and 1.0% and 66.8% in 72 hr, showing much overlap with normal. An index of the cumulative percentage of urinary 131I/125I X 100 at either 48 or 72 hr completely separated the groups, the index in normals ranging from 68.7 to 100 in 48 hr and 72.5 to 100 in 72 hr, whereas the malabsorbers varied between 2.0 and 64 in 48 hr and 2.2 and 67.5 in 72 hr.

Topics: Dietary Fats; Feces; Humans; Iodine Radioisotopes; Lipid Metabolism; Malabsorption Syndromes; Triolein

Bypassing the small intestine is used for the treatment of extreme obesity. Because of the altered morphological and functional situation, the assessment of radiological sequelae is different. Passage is rapid, continuous observation is essential. Passage time is related to weight loss. Multiple small fluid levels in the small intestine are an expression of the stasis in the bypassed intestinal loops. They are of clinical importance only when there are other complaints at the same time. A reflux is of particular importance in relation to the expected loss in weight. Absorption studies with radioactive isotopes show the extent of the malabsorption.

Topics: Cecum; Gastrointestinal Motility; Humans; Ileostomy; Intestines; Jejunum; Malabsorption Syndromes; Obesity; Postoperative Care; Radiography; Triolein

The preparation of a phenyl[1-14C]acetic acid oil is described. The absorption pattern of the phenylacetate in this oil is similar to that of oleic acid in triolein when examined in rats under conditions that may interfere with digestion and/or absorption. The safety of this compound, which is a normal metabolite, was established by the absence of the 14C label in various tissues five days after its administration to rats. When tested in 18 normal human volunteers 66.6 +/- 16.0 (S.D.) percent of the phenylacetate was recovered in a five hour urine collection. In two patients with malabsorption, less than 30% of the label was recovered in the urine over the same period. The half-life of the phenylacetate was determined to be 1-1.5 h. Our preliminary results indicate that phenylacetic oil may serve as a useful simple clinical test for fat absorption.

Topics: Absorption; Adult; Animals; Dietary Fats; Digestion; Humans; Lipid Metabolism; Malabsorption Syndromes; Male; Oils; Oleic Acids; Phenylacetates; Rats; Triolein; Zea mays

Topics: Adult; Bromine; Female; Humans; Iodine Radioisotopes; Malabsorption Syndromes; Male; Middle Aged; Oleic Acids; Postgastrectomy Syndromes; Radioisotopes; Stomach Neoplasms; Triolein

Topics: Adult; Aged; Celiac Disease; Cholesterol; Cocos; Drug Combinations; Fatty Acids; Female; Glycerol; Heparin; Humans; Hydrolysis; Infusions, Parenteral; Intestine, Small; Lipid Metabolism; Lipids; Lipoproteins, VLDL; Malabsorption Syndromes; Male; Middle Aged; Oils; Phosphatidylcholines; Sodium Chloride; Triglycerides; Triolein

Topics: Animals; Bile Acids and Salts; Blood Proteins; Cholesterol; Diarrhea; Disease Models, Animal; Feces; Female; Ileum; Iodine Radioisotopes; Malabsorption Syndromes; Male; Potassium; Rabbits; Sodium; Triglycerides; Triolein

Topics: Duodenal Ulcer; Feces; Female; Humans; Iodine Radioisotopes; Lipid Metabolism; Malabsorption Syndromes; Male; Oleic Acids; Postgastrectomy Syndromes; Triolein

Male rats were made deficient in essential fatty acids by feeding them a fat-free diet supplemented with 4% tripalmitin for 8-12 wk from the time of weaning. After feeding 0.5 ml of [(14)C]triolein or [(3)H]oleic acid, 72-hr stool recoveries of radioactivity were significantly greater in deficient rats than in chow-fed controls. Essential fatty acid deficiency did not reduce the absorptive capacities for triolein or for a medium-chain fat, trioctanoin, measured after 3 and 2 hr of maximal-rate duodenal infusion. In everted jejunal slices from essential fatty acid-deficient rats, uptake of micellar [(14)C]oleic acid at 0-1 degrees C was similar to that of controls, but the rate of incorporation of fatty acid into triglyceride after rewarming to 37 degrees C was significantly reduced. The specific activities of the microsomal esterifying enzymes, acyl CoA:monoglyceride acyltransferase and fatty acid CoA ligase in jejunal mucosa were 30% lower in essential fatty acid-deficient rats. However, the total microsomal enzyme activity adjusted to constant weight did not differ significantly in deficient rats compared with controls. After intraduodenal perfusion of triolein, accumulation of lipid in the intestinal wall was increased in the deficient rats. Because over 90% of the absorbed mucosal lipid was present as triglyceride, essential fatty acid deficiency appears to affect the synthesis or release of chylomicron lipid from the intestine. Analysis of regions of intestine showed that this delay in transport was most marked in the midportion of the small intestine.

Topics: Acyltransferases; Animals; Biological Transport; Carbon Isotopes; Chromatography, Gas; Chromatography, Thin Layer; Coenzyme A Ligases; Deficiency Diseases; Dietary Fats; Disease Models, Animal; Fatty Acids; Fatty Acids, Essential; Feces; Glycerides; Intestinal Mucosa; Jejunum; Kinetics; Lipids; Malabsorption Syndromes; Male; Oleic Acids; Rats; Time Factors; Triglycerides; Triolein; Tritium

Topics: Bile Acids and Salts; Blood Proteins; Chromium Isotopes; Diarrhea; Dietary Carbohydrates; Dietary Fats; Feces; Humans; Hydroxyproline; Intestinal Absorption; Intestinal Diseases, Parasitic; Malabsorption Syndromes; Nematode Infections; Oleic Acids; Protein-Losing Enteropathies; Schilling Test; Thiabendazole; Triolein; Xylose

Topics: Humans; Iodine Isotopes; Lipid Metabolism; Malabsorption Syndromes; Proteins; Serum Albumin, Radio-Iodinated; Triolein

Topics: Adult; Autoradiography; Celiac Disease; Chromatography; Dietary Fats; Feces; Female; Humans; Iodine Radioisotopes; Lipids; Malabsorption Syndromes; Male; Time Factors; Triolein

Topics: Amino Acids; Aminoisobutyric Acids; Ancylostomiasis; Anemia; Animals; Anthelmintics; Dietary Carbohydrates; Dietary Fats; Dog Diseases; Dogs; Intestinal Absorption; Intestine, Small; Iodine Isotopes; Malabsorption Syndromes; Nitrophenols; Triolein; Xylose

Topics: Carbon Isotopes; Chronic Disease; Enteritis; Feces; Gastrectomy; Humans; Intestinal Diseases; Iodine Radioisotopes; Lipid Metabolism; Malabsorption Syndromes; Methionine; Oleic Acids; Protein-Losing Enteropathies; Proteins; Serum Albumin, Radio-Iodinated; Stearic Acids; Triolein

Topics: Acromegaly; Addison Disease; Adult; Aged; Diabetes Complications; Endocrine System Diseases; Female; Glucose Tolerance Test; Humans; Intestinal Absorption; Malabsorption Syndromes; Male; Middle Aged; Thyroid Diseases; Triolein

Topics: Digestion; Humans; Intestinal Diseases; Iodine Isotopes; Lactose; Lipids; Malabsorption Syndromes; Oleic Acids; Proteins; Serum Albumin, Radio-Iodinated; Triolein; Vitamin B 12; Xylose

Topics: Anemia, Hypochromic; Animals; Blood Volume; Catalase; Cobalt; Copper; Electron Transport Complex IV; Female; Genes, Recessive; Intestinal Absorption; Iron; Iron Isotopes; Malabsorption Syndromes; Male; Mice; Sex Chromosomes; Triolein; Zinc

Topics: Bile Acids and Salts; Cholecystectomy; Digestion; Humans; Intestinal Absorption; Iodine Isotopes; Malabsorption Syndromes; Oleic Acids; Triolein; Yeast, Dried

Topics: Adult; Female; Gastrectomy; Humans; Intestinal Absorption; Iodine Radioisotopes; Lipid Metabolism; Malabsorption Syndromes; Male; Middle Aged; Oils; Postoperative Complications; Triolein

Topics: Celiac Disease; Dietary Fats; Humans; Iodine Radioisotopes; Malabsorption Syndromes; Pancreatectomy; Pancreatic Extracts; Triolein

Topics: Adult; Colon; Crohn Disease; Female; Humans; Ileum; Intestinal Absorption; Iodine Isotopes; Malabsorption Syndromes; Male; Middle Aged; Postoperative Complications; Triolein; Vitamin A; Vitamin B 12; Xylose

Topics: Animals; Carbon Isotopes; Gastric Mucosa; Humans; Hydrogen-Ion Concentration; Intestinal Absorption; Lipid Metabolism; Malabsorption Syndromes; Microsomes; Mitochondria; Pancreatic Juice; Rats; Triglycerides; Triolein

Topics: Animals; Bile Acids and Salts; Carbon Isotopes; Celiac Disease; Fatty Acids, Nonesterified; Gastrointestinal Motility; Hyperthyroidism; Intestinal Absorption; Linoleic Acids; Lipid Metabolism; Malabsorption Syndromes; Oleic Acids; Pancreatic Diseases; Rats; Triglycerides; Triolein

Topics: Animals; Diagnosis, Differential; Dog Diseases; Dogs; Female; Intestinal Absorption; Iodine; Iodine Isotopes; Malabsorption Syndromes; Male; Oleic Acids; Pancreatic Diseases; Triolein

Topics: Adult; Female; Fluoroscopy; Gastroenterostomy; Humans; Iodine Isotopes; Malabsorption Syndromes; Male; Middle Aged; Postoperative Complications; Triolein

Topics: Adult; Gastrectomy; Humans; Intestinal Absorption; Iodine Radioisotopes; Lipid Metabolism; Malabsorption Syndromes; Middle Aged; Postoperative Complications; Triolein

Malabsorption of fat in the adrenalectomized rat has been confirmed. The criteria for adrenal hypofunction were more rigorous than in previous studies. The malabsorption is not due to impaired intestinal lipolysis or inadequate intestinal intracellular glyceride synthesis. Delayed gastric emptying is probably secondary to the malabsorption rather than a cause. It is postulated that impaired intestinal fatty acid activation may be the key defect and that in some way this inhibits fatty acid transport across the mucosal membrane.

Topics: Adrenalectomy; Animals; Biological Transport; Digestion; Fats; Fatty Acids; In Vitro Techniques; Intestinal Absorption; Malabsorption Syndromes; Oleic Acids; Rats; Triolein

Topics: Animals; Dogs; Intestinal Absorption; Intestine, Small; Intestines; Iodine Isotopes; Lipid Metabolism; Malabsorption Syndromes; Postoperative Complications; Research; Surgical Procedures, Operative; Triolein

Topics: Aged; Animals; Bile Acids and Salts; Celiac Disease; Chromatography, Thin Layer; Escherichia coli; Feces; Humans; Intestine, Small; Lactobacillus; Malabsorption Syndromes; Male; Oleic Acids; Postoperative Complications; Rats; Tetracycline; Triolein

Topics: Aged; Aortography; Blood; Blood Vessel Prosthesis; Carotenoids; Celiac Artery; Fats; Feces; Female; Humans; Intestinal Absorption; Intestinal Diseases; Malabsorption Syndromes; Mesenteric Vascular Occlusion; Triolein; Xylose

Absorption of radioiodinated triolein was tested in 93 individuals (15 controls, 28 cases of functional diarrhea, and 50 patients with suspected or manifest malabsorption syndrome).The results so obtained were compared in 59 cases with estimations of fecal radioactivity and chemically determined fecalfat excretion. A highly significant correlation was found.The urinary xylose excretion test was performed in 96 individuals. The diagnostic value of the radioactive fat absorption test was compared with that of the xylose excretion test in 78 cases. Both tests were diagnostic in cases of non-tropical sprue, but the xylose excretion test reflected the clinical improvement more accurately in treated cases. The radioactive fat absorption test was more reliable in the diagnosis of malabsorption secondary to bowel resection than was the xylose excretion test, but the converse was true in the diagnosis of malabsorption secondary to gastrectomy. The simultaneous use of these two tests was found to be a simple and reliable screening procedure.

Topics: Body Fluids; Celiac Disease; Clinical Laboratory Techniques; Colitis; Colitis, Ulcerative; Crohn Disease; Diagnosis, Differential; Diarrhea; Enteritis; Feces; Gastrectomy; Iodine Isotopes; Lipid Metabolism; Malabsorption Syndromes; Pancreatitis; Sprue, Tropical; Surgical Procedures, Operative; Triolein; Urine; Xylose

Topics: Celiac Disease; Enzymes; Gastrointestinal Agents; Iodine Isotopes; Malabsorption Syndromes; Sprue, Tropical; Tablets; Triolein

Topics: Arteriosclerosis; Diarrhea; Edema; Emaciation; Geriatrics; Glucose Tolerance Test; Humans; Ileum; Intestinal Diseases; Intestine, Small; Jejunum; Malabsorption Syndromes; Mesenteric Vascular Occlusion; Oleic Acid; Pathology; Radiography; Triolein; Ulcer; Xylose

Topics: Colitis, Ulcerative; Crohn Disease; Enteritis; Fats; Feces; Gallbladder Diseases; Humans; Iodine Isotopes; Lipid Metabolism; Liver Diseases; Malabsorption Syndromes; Postgastrectomy Syndromes; Triolein

Topics: Biomedical Research; Bromine; Feces; Heart Diseases; Humans; Intestinal Absorption; Iodine; Iodine Isotopes; Malabsorption Syndromes; Oleic Acid; Oleic Acids; Radioisotopes; Triolein; Urine

Topics: Animals; Cobalt Isotopes; Corrinoids; Digestion; Dogs; Intestinal Absorption; Iodine Isotopes; Malabsorption Syndromes; Research; Triolein; Tritium; Vitamin B 12

Topics: Biomedical Research; Fats; Humans; Intestinal Absorption; Iodine Isotopes; Lipid Metabolism; Malabsorption Syndromes; Triolein

Topics: Blood; Celiac Disease; Diet; Fats; Feces; Iodine Isotopes; Malabsorption Syndromes; Neomycin; Sprue, Tropical; Toxicology; Triolein

Topics: Alkaline Phosphatase; Blood; Body Weight; Calcium Metabolism Disorders; Calcium, Dietary; Celiac Disease; Creatine; Creatinine; Feces; Gastrectomy; Humans; Malabsorption Syndromes; Osteoporosis; Peptic Ulcer; Postgastrectomy Syndromes; Triolein; Urine