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. 1993 Sep;69(3):366–370. doi: 10.1136/adc.69.3.366

Measurement of fat digestion in early life using a stable isotope breath test.

P McClean 1, M Harding 1, W A Coward 1, M R Green 1, L T Weaver 1
PMCID: PMC1029522  PMID: 8215547

Abstract

13C breath tests are a safe, non-invasive way of assessing nutrient digestion and absorption that can be used repeatedly in infancy and childhood. The aim of this study was to assess their value for measuring fat digestion in infants and young children with cystic fibrosis, and healthy controls whose pancreatic exocrine function is immature, and to monitor pancreatic enzyme supplementation. Six infants with cystic fibrosis (aged 10-18 months) and nine healthy controls (aged 6-19 months) were studied. After an overnight fast each child ingested 7.5 mg/kg 13C trioctanoin (99 atom % excess) followed by a known volume of milk. Breath samples were collected before and at 30 minute intervals thereafter for five hours. The 13C enrichment of expired carbon dioxide was measured by gas isotope ratio mass spectrometry. The mean (SD) percentage dose recovery of 13C was 13.5 (5.3) for the cystic fibrosis group and 24.2 (6.7) for the healthy controls. When those with cystic fibrosis were studied after supplementary pancreatic enzymes, the mean percentage dose recovery rose to 17.1 (6.9). Total intraluminal lipolysis was diminished by 44% in young children with cystic fibrosis. Pancreatic enzyme supplements improved digestion by 27%. The 13C trioctanoin breath test was effective in detecting fat maldigestion and can be used to measure the benefits of enzyme supplements in early life.

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Selected References

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  1. Beverley D. W., Kelleher J., MacDonald A., Littlewood J. M., Robinson T., Walters M. P. Comparison of four pancreatic extracts in cystic fibrosis. Arch Dis Child. 1987 Jun;62(6):564–568. doi: 10.1136/adc.62.6.564. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Eggermont E. The role of the small intestine in cystic fibrosis patients. Acta Paediatr Scand Suppl. 1985;317:16–21. doi: 10.1111/j.1651-2227.1985.tb14929.x. [DOI] [PubMed] [Google Scholar]
  3. Hamosh M., Klaeveman H. L., Wolf R. O., Scow R. O. Pharyngeal lipase and digestion of dietary triglyceride in man. J Clin Invest. 1975 May;55(5):908–913. doi: 10.1172/JCI108019. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Hamosh M., Scanlon J. W., Ganot D., Likel M., Scanlon K. B., Hamosh P. Fat digestion in the newborn. Characterization of lipase in gastric aspirates of premature and term infants. J Clin Invest. 1981 Mar;67(3):838–846. doi: 10.1172/JCI110101. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Kane R. E., Hobbs P. Energy and respiratory metabolism in cystic fibrosis: the influence of carbohydrate content of nutritional supplements. J Pediatr Gastroenterol Nutr. 1991 Feb;12(2):217–223. doi: 10.1097/00005176-199102000-00014. [DOI] [PubMed] [Google Scholar]
  6. Lebenthal E., Lee P. C. Development of functional responses in human exocrine pancreas. Pediatrics. 1980 Oct;66(4):556–560. [PubMed] [Google Scholar]
  7. McClean P., Weaver L. T. Ontogeny of human pancreatic exocrine function. Arch Dis Child. 1993 Jan;68(1 Spec No):62–65. doi: 10.1136/adc.68.1_spec_no.62. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Mundlos S., Kühnelt P., Adler G. Monitoring enzyme replacement treatment in exocrine pancreatic insufficiency using the cholesteryl octanoate breath test. Gut. 1990 Nov;31(11):1324–1328. doi: 10.1136/gut.31.11.1324. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Murphy M. S., Eastham E. J., Nelson R., Aynsley-Green A. Non-invasive assessment of intraluminal lipolysis using a 13CO2 breath test. Arch Dis Child. 1990 Jun;65(6):574–578. doi: 10.1136/adc.65.6.574. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Newcomer A. D., Hofmann A. F., DiMagno E. P., Thomas P. J., Carlson G. L. Triolein breath test: a sensitive and specific test for fat malabsorption. Gastroenterology. 1979 Jan;76(1):6–13. [PubMed] [Google Scholar]
  11. O'Rawe A., McIntosh I., Dodge J. A., Brock D. J., Redmond A. O., Ward R., Macpherson A. J. Increased energy expenditure in cystic fibrosis is associated with specific mutations. Clin Sci (Lond) 1992 Jan;82(1):71–76. doi: 10.1042/cs0820071. [DOI] [PubMed] [Google Scholar]
  12. Roy C. C., Weber A. M., Lepage G., Smith L., Levy E. Digestive and absorptive phase anomalies associated with the exocrine pancreatic insufficiency of cystic fibrosis. J Pediatr Gastroenterol Nutr. 1988;7 (Suppl 1):S1–S7. doi: 10.1097/00005176-198811001-00002. [DOI] [PubMed] [Google Scholar]
  13. SCHWABE A. D., BENNETT L. R., BOWMAN L. P. OCTANOIC ACID ABSORPTION AND OXIDATION IN HUMANS. J Appl Physiol. 1964 Mar;19:335–337. doi: 10.1152/jappl.1964.19.2.335. [DOI] [PubMed] [Google Scholar]
  14. Shreeve W. W., Cerasi E., Luft R. Metabolism of [2-14C] pyruvate in normal, acromegalic and hgh-treated human subjects. Acta Endocrinol (Copenh) 1970 Sep;65(1):155–169. doi: 10.1530/acta.0.0650155. [DOI] [PubMed] [Google Scholar]
  15. Vaisman N., Pencharz P. B., Corey M., Canny G. J., Hahn E. Energy expenditure of patients with cystic fibrosis. J Pediatr. 1987 Oct;111(4):496–500. doi: 10.1016/s0022-3476(87)80107-5. [DOI] [PubMed] [Google Scholar]
  16. Vantrappen G. R., Rutgeerts P. J., Ghoos Y. F., Hiele M. I. Mixed triglyceride breath test: a noninvasive test of pancreatic lipase activity in the duodenum. Gastroenterology. 1989 Apr;96(4):1126–1134. doi: 10.1016/0016-5085(89)91632-6. [DOI] [PubMed] [Google Scholar]
  17. Watkins J. B., Klein P. D., Schoeller D. A., Kirschner B. S., Park R., Perman J. A. Diagnosis and differentiation of fat malabsorption in children using 13C-labeled lipids: trioctanoin, triolein, and palmitic acid breath tests. Gastroenterology. 1982 May;82(5 Pt 1):911–917. [PubMed] [Google Scholar]
  18. Watkins J. B., Schoeller D. A., Klein P. D., Ott D. G., Newcomer A. D., Hofmann A. F. 13C-trioctanoin: a nonradioactive breath test to detect fat malabsorption. J Lab Clin Med. 1977 Sep;90(3):422–430. [PubMed] [Google Scholar]

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