Fat maldigestion

Cystic fibrosis (CF) is a recessive genetic disorder prevalent among whites in North America and certain parts of northern Europe. It is characterized by chronic bacterial infections of the airways and sinuses, fat maldigestion due to pancreatic exocrine insufficiency, infertility in males due to abnormal development of the vas deferens, and elevated levels of chloride in sweat (> 60 mmol/L). 

Laboratory testing confirms the diagnosis of CF, and Jessica has been referred to her regional CF center for treatment. Additional stool studies indicate the presence of severe fat maldigestion. The pulmonologist indicates that she would like to start Jessica (weight 8.2 kg) on pancreatic enzyme replacement therapy. 

Most of fhe above-mentioned bioavailability, intervention, and case studies came to the conclusion that water-miscible or water-soluble preparations of faf-soluble vitamins were superior to regular supplements. Based on the evidence from our own bioavailability study as well as from fhe studies mentioned above, it therefore seems justified to assume that fat-soluble vitamin deficit patients with fat maldigestion and/or malabsorption can be corrected more efficiently by using water-soluble as opposed to fat-soluble preparations. Another advantage of water-soluble preparations in general might be that lower daily doses are required when compared to fat-soluble preparations to achieve the same results. 

Maldigestion results in decreased serum levels of the fat-soluble vitamins A, D, E, and K. 

Exocrine pancreatic insufficiency is most commonly caused by cystic fibrosis, chronic pancreatitis, or pancreatic resection. When secretion of pancreatic enzymes falls below 10% of normal, fat and protein maldigestion occur which can lead to steatorrhea, azotorrhea, vitamin malabsorption, and weight loss. Pancreatic enzyme supplements, which contain a mixture of amylase, lipase, and proteases, are the mainstay of treatment for pancreatic enzyme insufficiency. Two major types of preparations in use are pancreatin and pancrelipase. Pancreatin is an alcohol-derived extract of... 

T. Nakamura, T. Takeuchi, A. Terada, Y. Tando, and T. Suda, Near-Infrared Spectrometry Analysis of Fat, Neutral Sterols, Bile Acids, and Short-Chain Fatty Acids in the Feces of Patients with Pancreatic Maldigestion and Malabsorption, Int. J. Pancreatol., 23(2), 137-143 (1998). 

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