Role in Lipid Absorption

Condition Choles-BA terol BA Choles- terol Choles-BA terol BA NS  

Cholesterol and fat-soluble vitamins require bile acid induced micellar solubilization for absorption, which takes place in the upper small intestine (c/. 32,116-118). Accordingly, in bile salt deficiency states, cholesterol absorption should be markedly impaired and fecal neutral sterol excretion increased. The fact that fecal neutral steroid excretion on a low-cholesterol diet is actually normal, as after ileal resection, ileal bypass, and cholestyramine treatment, or even decreased, as in cirrhosis of the liver or biliary occlusion (11), is due to a markedly reduced biliary secretion of cholesterol. In gluten enteropathy, in which no excessive bile salt loss usually exists, fecal neutral sterol excretion is markedly augmented (119). However, in occasional cases in which fecal bile salt elimination is markedly enhanced, the fecal neutral steroid excretion is quite normal, probably owing to decreased biliary cholesterol secretion as a consequence of low biliary bile salt secretion. Detailed information on the role of bile salts in both intraluminal and mucosal phases of fat and sterol absorption is presented in many recent reviews (6,10,113,114,117). 

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Bile salts are substances derived from sterols, which make up a substantial part of the solid matter in bile and which play a central role in lipid absorption, by virtue of their surface-active properties. The structure and properties of these salts have been reviewed by Haslewood (305) and Heaton (316). Bile salts essentially have molecules of detergent type hydrocarbon, with a fat-dissolving part and a polar, water-attracting part. The fat-dissolving part consists of the bulk of the steroid nucleus. The hydroxyl groups are so distributed that hydration can readily take place the remainder of the molecule will dissolve the fatty phase. Emulsification of fat/water complexes can thus occur easily. The terms bile acid and bile salt are used somewhat interchangeably in the literature. 

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