Fat excretion

Fig. 9. Effect of short-term rifaximin administration (400 mg t.i.d. for 7 days) on diarrhea (a) and fecal fat excretion (b) in patients with chronic pancreatitis with and without SIBO (from Trespi and Fer-rieri [201]).

In addition to ANP where it is associated with GI dys-motility [198, 199], SIBO is present in a significant proportion of patients with chronic pancreatitis [200, 201], Short-term rifaximin therapy was able to normalize the hydrogen breath test and improve symptoms (i.e. diarrhea and fecal fat excretion) in all patients studied (fig. 9) [201]. Bowel decontamination via administration of this topical antibiotic could, therefore, be beneficial in both acute and chronic pancreatitis. Double-blind, placebo-controlled studies are to be performed to explore the rifaximin potential in this indication. 

All. Asenjo, C. F., Rodriguez-Molina, R., Cancio, M., and Bemabe, R. A., Influence of very low fat diets, with and without gluten, on the endogenous fecal-fat excretion of patients with tropical sprue. Am. J. Trop. Med. Hyg. 7, 347-352 (1958). 

J. H. Cummings, Ft. S. Wiggins, D. J. A. Jenkins, H. Houston, T. Jivraj, B. S. Drasar and M. J. Hill, Influence of diets high and low in animal fat on bowel habit, gastro-intestinal transit time, fecal microflora, bile acid, and fat excretion, J. Clin. Invest., 1978, 61, 953. 

Hemagglutinin activity. Saline extract of the dried seed, at a concentration of 10%, was active on the human red blood cells L Hypocholestrolemic activity. Fresh root, taken orally by human adults at a dose of 200 g/person, was active. Daily ingestion at breakfast for 3 weeks decreased cholesterol in serum by 11%, increased fecal bile acid and fat excretion by 50%, and increased stool weight by 25%° . 

Fecal steroid and lipid excretion. Fiber supplements from sugar cane residue (bagasse), administered to volunteers for 12 weeks, increased stool weights and stool fat excretion. Bagasse increased the daily loss of acid steroids and decreased transit time without alteration in fecal flora. The increased excretion of bile acids and fatty acids failed to lower the plasma cholesterol and TGs after 12 weeks ". 

Lengsfeld, H., Fleury, A., Nolte, M., Piquerez, J. C, Hadvary, P., and Beglinger, C. (1999). Effect of orlistat and chitosan on faecal fat excretion in young healthy volunteers. Obes. Res. 7(Suppl. 1), 50S. 

Octreotide 100 pg given subcutaneously to five healthy subjects 30 minutes before meals for 7 days increased fecal fat excretion however, steatorrhea occurred in only two cases fecal bile acid excretion fell to about 25% (35)... 

The effects of pancreatic exocrine supplements (four capsules with meals, two with snacks each capsule containing lipase 10 000 units, protease 37 500 units, amylase 33 200 units) on glucose metabolism have been studied in a 2-week parallel, randomized, placebo-controlled trial in 29 patients with chronic pancreatitis who had stool fat excretion of over 10 g/day, 18 of whom were diabetic and 15 of whom were malnourished (902). There were major problems with blood glucose control in 28 of the 29 patients. 

Fat oxidation greater overall fat excretion Increased energy expenditure Cummings et al. 

Jacobsen, R., Lorenzen, J. K., Toubro, S., Krog-Mikkelsen, I., and Astrup, A. (2005). Effect of short-term high dietary calcium intake on 24-h energy expenditure, fat oxidation, and fecal fat excretion. Int. J. Obes. (Lond.) 29, 292-301. 

Gallaher, C.M., Munion, J., Hesslink, R., Jr., Wise, J., and Gallaher, D.D. 2000. Cholesterol reduction by glucomannan and chitosan is mediated by changes in cholesterol absorption and bile acid and fat excretion in rats. J. Nutr. 130, 2753-2759. 

Gades, Matthew D., and Judith S. Stern. "Chitosan Supplementation and Fecal Fat Excretion in Men." Obesity Research 11 (2003) 683-688. Available online. URL www. obesityresearch. org/cgi/content/abstract/11/5/683. Accessed November 13, 2007. 

Normally there is very little fat in the feces. However, fat content in stools may increase because of various fat malabsorption syndromes. Such increased fat excretion is steatorrhea. Decreased fat absorption may be the result of failure to emulsify food contents because of a deficiency in bile salts, as in liver disease or bile duct obstruction (stone or tumor). Pancreatic insufficiency may result in an inadequate pancreatic lipase supply. Finally, absorption itself may be faulty because of damage to intestinal mucosal cells through allergy or infection. An example of allergy-based malabsorption is celiac disease, which is usually associated with gluten intolerance. Gluten is a wheat protein. An example of intestinal infection is tropical sprue, which is often curable with tetracycline. Various vitamin deficiencies may accompany fat malabsorption syndromes. 

Quantitative fecal fat excretion was markedly increased (28 g/day normal is <7 g/day), and fecal elastase 1 concentration was reduced to 24 pg/g (lower level of normal is 200 pg/g).The patient was diagnosed with severe pancreatic exocrine (but not endocrine) insufficiency due to alcoholic chronic calcifying pancreatitis and advised to stop alcohol and cigarette consumption. 

The coefficient of fat absorption is defined as the amount of fat absorbed as a percentage of the ingested amount. This coefficient normally exceeds 93% and is used (rather than crude fecal fat excretion) to indicate efficacy of luminal fat digestion following different dietary lipid intakes. By contrast, fecal carbohydrate measurements do not fully reflect the extent of starch malabsorption because carbohydrates are metabolized by the intracolonic microbial flora. Since intracolonic metabolism of carbohydrates... 

Measurement of stool weight and quantitative fecal fat excretion on three consecutive days during a balanced diet are common screening tests for both pancreatic insufficiency and other pathologies that result in malabsorption. However, these tests are insensitive and nonspecific for pancreatic malfunction Steatorrhea occurs only after loss of more than 90% of exocrine parenchyma, and other causes of malabsorption (e.g., celiac sprue or Crohn s disease) may also induce abnormal fecal fat excretion of more than 7 g/day or more than 5 g/100 g. 

No significant differences were found in mean fecal fat excretions (Table VIII). Failure to detect differences in fecal fat may indicate that the increase in total fat content of the usual versus the modified fat diet is compensated for by an increase in absorption of fat. Increased absorption of fat, then, could account for the higher serum HDL-cholesterol and triglycerides levels caused by the two higher fat treatments. 

In conclusion, serum, liver and brain lipid concentrations, body weight change and fecal fat excretions were greater in rats fed a diet with 25% fat than in rats fed a lower fat diet. Within each level of fat, total liver lipids decreased and liver cholesterol concentration increased as level of dietary manganese increased. However, in 14 adult, human subjects fed two levels of dietary fat, dietary manganese had no effect on serum lipid parameters or fecal fat excretion. 

Table VIII. Mean Fecal Fat Excretions (g/day) of Humans Fed Varying Levels of Manganese and Fat...

Steatorrhoea is the formation of non-solid faeces. Floating stools, due to excess fat, are oily in appearance and foul smelling. There is increased fat excretion, which can be measured by determining the faecal fat level. Possible biological causes can be lack of bile acids (due to liver damage or hypolipidaemic drugs), defects or a reduction in pancreatic enzymes (lipase), and defective mucosal cells. The absence of bile acids will cause the faeces to turn grey or pale. 

It is also often forgotten that diarrhea increases fecal fat excretion. In 58% of subjects with normal fat excretion, experimental induction of severe diarrhea (fecal weight >800g/day) led to increased fecal fat (values of up to 49mmol/day). A borderline increase in fecal fat (i.e., 2 to 3 times the upper limit of normal, which is 18mmol/day) is therefore not specific for a primary defect in fat digestion or absorption. 

Fine KD, Fordtran JS. The effect of diarrhea on fecal fat excretion. Gastroenterology 1992 102 1936-9. 

Similar experiments were performed without gastric and duodenal tubes, and fat absorption was indirectly measured from fecal fat excretion. As predicted from... 

Tab. 10.7 Effects of Orlistat on fat excretion after ingestion of liquid and solid meals by healthy volunteers. Values are means SD. The number of volunteers is indicated in brackets.

Chung, )., Kinberg, J., Hauptman, J.B. and Patel, LH. (1994) Retrospective population-based analysis of the dose-response (fecal fat excretion) relationship of orlistat in normal and obese volunteers. Clin. Pharmacol. Ther. 56, 82-85. 

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