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Hirsch TI, Wang SZ, Fligor SC, Quigley M, Gura KM, Puder M, Tsikis ST. Fat malabsorption in short bowel syndrome: A review of pathophysiology and management. Nutr Clin Pract 2024; 39 Suppl 1:S17-S28. [PMID: 38429962 PMCID: PMC10914324 DOI: 10.1002/ncp.11119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/13/2023] [Accepted: 12/28/2023] [Indexed: 03/03/2024] Open
Abstract
Fat malabsorption is central to the pathophysiology of short bowel syndrome (SBS). It occurs in patients with insufficient intestinal surface area and/or function to maintain metabolic and growth demands. Rapid intestinal transit and impaired bile acid recycling further contribute to fat malabsorption. A significant portion of patients require parenteral nutrition (PN) for their survival but may develop sepsis and liver dysfunction as a result. Despite advancements in the treatment of SBS, fat malabsorption remains a chronic issue for this vulnerable patient population. Peer-reviewed literature was assessed on the topic of fat malabsorption in SBS. Current management of patients with SBS involves dietary considerations, PN management, antidiarrheals, glucagon-like peptide 2 agonists, and multidisciplinary teams. Clinical trials have focused on improving intestinal fat absorption by facilitating fat digestion with pancreatic enzymes. Targeting fat malabsorption in SBS is a potential pathway to improving lifestyle and reducing morbidity and mortality in this rare disease.
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Affiliation(s)
- Thomas I. Hirsch
- Vascular Biology Program, Department of Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Sarah Z. Wang
- Vascular Biology Program, Department of Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Scott C. Fligor
- Vascular Biology Program, Department of Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Mikayla Quigley
- Vascular Biology Program, Department of Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Kathleen M. Gura
- Department of Pharmacy and the Division of Gastroenterology and Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark Puder
- Vascular Biology Program, Department of Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Savas T. Tsikis
- Vascular Biology Program, Department of Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
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Mortensen A, Aguilar F, Crebelli R, Di Domenico A, Dusemund B, Frutos MJ, Galtier P, Gott D, Gundert-Remy U, Leblanc JC, Lindtner O, Moldeus P, Mosesso P, Parent-Massin D, Oskarsson A, Stankovic I, Waalkens-Berendsen I, Woutersen RA, Wright M, Younes M, Boon P, Chrysafidis D, Gürtler R, Tobback P, Gergelova P, Rincon AM, Lambré C. Re-evaluation of fatty acids (E 570) as a food additive. EFSA J 2017; 15:e04785. [PMID: 32625490 PMCID: PMC7009963 DOI: 10.2903/j.efsa.2017.4785] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
The EFSA Panel on Food Additives and Nutrient Sources added to Food (ANS) provides a scientific opinion re-evaluating the safety of fatty acids (E 570) when used as a food additive. The food additive includes caprylic- (C8), capric- (C10), lauric- (C12), myristic- (C14), palmitic- (C16), stearic- (C18) and oleic acid (C18:1), present alone or in combination. In 1991, the Scientific Committee on Food (SCF) established a group acceptable daily intake (ADI) 'not specified' for the fatty acids (myristic, stearic, palmitic and oleic acid). The fatty acids (E 570) are absorbed in the same way as the free fatty acids from the regular diet. They show low acute toxicity. The available studies on subchronic toxicity were limited but there was no evidence for toxic effects at doses up to 10% in the diet (equivalent to 9,000 mg lauric acid/kg body weight (bw) per day). The Panel considered that the fatty acids (E 570) did not raise a concern for genotoxicity. Data on chronic toxicity, reproductive toxicity and developmental toxicity were too limited to reach a conclusion on these endpoints. The Panel noted that the contribution of fatty acids (E 570) represented on average only 1% of the overall exposure to saturated fatty acids from all dietary sources (food additive and regular diet). Based on the approach described in the conceptual framework for the risk assessment of certain food additives re-evaluated under Commission Regulation (EU) No 257/2010 and taking into account the considerations mentioned above, the Panel concluded that the food additive fatty acids (E 570) was of no safety concern at the reported uses and use levels.
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Kristensen JB, Jørgensen H, Mu H. Absorption difference between diacylglycerol oil and butter blend containing diacylglycerol oil. EUR J LIPID SCI TECH 2011. [DOI: 10.1002/ejlt.201100115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Carten JD, Bradford MK, Farber SA. Visualizing digestive organ morphology and function using differential fatty acid metabolism in live zebrafish. Dev Biol 2011; 360:276-85. [PMID: 21968100 DOI: 10.1016/j.ydbio.2011.09.010] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Revised: 09/13/2011] [Accepted: 09/13/2011] [Indexed: 01/05/2023]
Abstract
Lipids are essential for cellular function as sources of fuel, critical signaling molecules and membrane components. Deficiencies in lipid processing and transport underlie many metabolic diseases. To better understand metabolic function as it relates to disease etiology, a whole animal approach is advantageous, one in which multiple organs and cell types can be assessed simultaneously in vivo. Towards this end, we have developed an assay to visualize fatty acid (FA) metabolism in larval zebrafish (Danio rerio). The method utilizes egg yolk liposomes to deliver different chain length FA analogs (BODIPY-FL) to six day-old larvae. Following liposome incubation, larvae accumulate the analogs throughout their digestive organs, providing a comprehensive readout of organ structure and physiology. Using this assay we have observed that different chain length FAs are differentially transported and metabolized by the larval digestive system. We show that this assay can also reveal structural and metabolic defects in digestive mutants. Because this labeling technique can be used to investigate digestive organ morphology and function, we foresee its application in diverse studies of organ development and physiology.
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Affiliation(s)
- Juliana Debrito Carten
- The Johns Hopkins University, Department of Biology, 3400 North Charles Street, Baltimore, MD 21218, USA.
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Vemuri M, Kelley D. The Effects of Dietary Fatty Acids on Lipid Metabolism. FATTY ACIDS IN FOODS AND THEIR HEALTH IMPLICATIONS,THIRD EDITION 2007. [DOI: 10.1201/9781420006902.ch23] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Linderborg (née Yli-Jokipii) KM, Kallio HPT. Triacylglycerol Fatty Acid Positional Distribution and Postprandial Lipid Metabolism. FOOD REVIEWS INTERNATIONAL 2005. [DOI: 10.1080/fri-200061623] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Fruekilde MB, Høy CE. Lymphatic fat absorption varies among rats administered dairy products differing in physiochemical properties. J Nutr 2004; 134:1110-3. [PMID: 15113954 DOI: 10.1093/jn/134.5.1110] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We examined in rats the intestinal absorption of fat from dairy products differing in physiochemical properties. Five dairy products (cream cheese, cream, sour cream, butter, and mixed butter) with minor differences in fatty acid composition were administered by gavage to rats, and lymphatic fat absorption was examined. Absorption was followed for 8 h after administration of 300 mg fat from the dairy products. Administration of cream and sour cream resulted in faster lymphatic fat absorption than cream cheese, butter, and mixed butter, and at 8 h the accumulated absorption of fat was significantly higher. The lymphatic absorption of fat after cream cheese administration was similar to the absorption after butter and mixed butter administration up to the 4-h time point; then it increased to a level between that of rats administered cream or sour cream and butter or mixed butter. Overall, these results demonstrated different lymphatic absorption patterns of fat from dairy products differing in physiochemical properties. Because the fatty acid composition of the dairy products differed only slightly, other factors such as viscosity, type of emulsion, particle size, and likely also protein content may have contributed to the differences in absorption.
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Affiliation(s)
- Maj-Britt Fruekilde
- BioCentrum-DTU, Biochemistry and Nutrition Group, and Centre for Advanced Food Studies, The Technical University of Denmark, Lyngby, Denmark.
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Transport of 13C-labelled linoleic and 13C-labelled caprylic acid in rat plasma after administration of specific structured triacylglycerols. Nutr Res 2004. [DOI: 10.1016/j.nutres.2003.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
The presence of medium-chain fatty acids in dietary fatty acid as well as the triacylglycerol structure may influence the absorption and lymphatic transport of fatty acids. We compared the lymphatic transport and recovery of fatty acids from four intragastrically administered fats based on rapeseed oil and decanoic acid in two rat models of normal absorption and malabsorption, respectively. The fats were: 1) a fat with a regiospecific structure, 2) a similar fat but with a random distribution of fatty acids in the triacylglycerol molecule, 3) a physical mixture of tridecanoin and rapeseed oil and 4) rapeseed oil as control. Lymph samples were collected for 24 h. Significantly higher recoveries were observed of total fatty acids, oleic acid, linoleic acid and linolenic acid from the specific oil in malabsorbing rats and of linoleic acid in normal rats fed specific oil compared with those fed rapeseed oil. Furthermore, the recoveries of oleic acid and linolenic acid from the specific oil in normal rats were higher than those from the other oils. In malabsorbing rats, the transport of all fats was approximately 90% less than that of normal rats. The present study demonstrates improved hydrolysis and absorption of the specific oil compared with the other oils examined both in rats with normal absorption and in rats with malabsorption.
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Affiliation(s)
- E M Straarup
- Center for Advanced Food Studies and Department of Biochemistry and Nutrition, The Technical University of Denmark, DK-2800 Lyngby, Denmark
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Porsgaard T, Høy CE. Lymphatic transport in rats of several dietary fats differing in fatty acid profile and triacylglycerol structure. J Nutr 2000; 130:1619-24. [PMID: 10827219 DOI: 10.1093/jn/130.6.1619] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We examined in rats the intestinal absorption of nine very different dietary fats (two rapeseed oils, corn, olive, palm and menhaden oil, butter, cocoa butter and lard) to investigate the influence of fatty acid profile and triacylglycerol structure on absorption. Absorption was followed for 24 h after administration of similar amounts of fats, and the accumulated lymphatic transport and amount of triacylglycerols found in lymph in response to the administered fats were calculated, revealing major differences. The transport of olive and low alpha-linolenic rapeseed oil was significantly higher than that of the other fats (P < 0.05), except corn oil. The lymphatic transport of the other fats followed a slower course, with cocoa butter and menhaden oil having the lowest amounts transported. The amount of triacylglycerols found in lymph in response to the administered fats at 8 h ranged from 27.5% of the administered dose for cocoa butter to 72.1% for olive oil. The value for cocoa butter was significantly lower than that for most other fats. At 24 h, the values ranged from 66.5% for cocoa butter to 121.2% for olive oil. The high value for olive oil suggested transport of endogenous as well as exogenous fatty acids. The low value observed after cocoa butter resulted from decreased lipolysis and possibly also low absorption of triacylglycerols with high levels of long-chain saturated fatty acids in the sn-1/3 position. Furthermore, a low value was observed after menhaden oil administration, suggesting decreased absorption of fats containing (n-3) long-chain polyunsaturated fatty acids. Overall, these results demonstrate the influence of the fatty acid composition and triacylglycerol structure on the lymphatic absorption of dietary fat.
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Affiliation(s)
- T Porsgaard
- Department of Biochemistry and Nutrition, The Technical University of Denmark, DK-2800 Lyngby, Denmark
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Time-related fatty acid profiles of plasma and lymph after gastric administration of fats to rats fed high-fat diets. Nutr Res 2000. [DOI: 10.1016/s0271-5317(00)00147-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Papamandjaris AA, MacDougall DE, Jones PJ. Medium chain fatty acid metabolism and energy expenditure: obesity treatment implications. Life Sci 1998; 62:1203-15. [PMID: 9570335 DOI: 10.1016/s0024-3205(97)01143-0] [Citation(s) in RCA: 222] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Fatty acids undergo different metabolic fates depending on their chain length and degree of saturation. The purpose of this review is to examine the metabolic handling of medium chain fatty acids (MCFA) with specific reference to intermediary metabolism and postprandial and total energy expenditure. The metabolic discrimination between varying fatty acids begins in the GI tract, with MCFA being absorbed more efficiently than long chain fatty acids (LFCA). Subsequently, MCFA are transported in the portal blood directly to the liver, unlike LCFA which are incorporated into chylomicrons and transported through lymph. These structure based differences continue through the processes of fat utilization; MCFA enter the mitochondria independently of the carnitine transport system and undergo preferential oxidation. Variations in ketogenic and lipogenic capacity also exist. Such metabolic discrimination is supported by data in animals and humans showing increases in postprandial energy expenditure after short term feeding with MCFA. In long term MCFA feeding in animals, weight accretion has been attenuated. These differences in metabolic handling of MCFA versus LCFA are considered with the conclusion that MCFA hold potential as weight loss agents.
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Affiliation(s)
- A A Papamandjaris
- School of Dietetics and Human Nutrition, Faculty of Agricultural and Environmental Sciences, McGill University, Macdonald Campus, Ste-Anne-de-Bellevue, Quebec
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You YQ, Ling PR, Qu Z, Bistrian BR. Effect of continuous enteral medium-chain fatty acid infusion on lipid metabolism in rats. Lipids 1998; 33:261-6. [PMID: 9560800 DOI: 10.1007/s11745-998-0204-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This study compared (i) the relative effects of long-chain triglycerides (LCT) and medium-chain triglycerides (MCT), (ii) the influence of amount of MCT, and (iii) the impact of medium-chain fatty acid position, on plasma and lymphatic triglycerides and portal vein free fatty acids. The animals were fed approximately at 250 kcal/kg.day for 20 h. The lymph from lymphatic duct and blood from portal vein and systemic circulation were collected. The results showed that feeding 100% MCT for 20 h was sufficiently long to reduce significantly the level of linoleic acid in portal vein fatty acids and plasma and lymph triglycerides. However, this alteration induced by MCT feeding was partially prevented by adding LCT to the diet. The level of arachidonic acid was significantly reduced in plasma triglycerides by any of the diets containing medium-chain fatty acids compared to 100% LCT. When feeding MCT only, palmitoleic acid, presumably reflecting de novo lipogenesis, was increased in lymphatic triglycerides and portal vein fatty acids. Total saturated fatty acids as a total percentage of total fatty acids were also significantly increased in plasma and lymphatic triglycerides and portal vein fatty acids. Thus, when linoleic acid is limiting, the conversion of MCT into long-chain fatty acids by de novo lipogenesis is likely to be an important metabolic route. Providing LCT with MCT or 2-monodecanoin appears to limit this pathway.
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Affiliation(s)
- Y Q You
- Laboratory of Nutrition/Infection, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Partition of oleic acid between the lymph and portal blood in rats having a diverted bile-pancreatic duct. Br J Nutr 1996. [DOI: 10.1017/bjn19960128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractThe present study examines the suggestion that in the absence of adequate bile and pancreatic juice, which support the absorption from the gut of long-chain fatty acidsinto lymph, the fatty acids are absorbed directly into the portal blood. Oleic acid (18:l) partitioning between lymph and portal blood was investigated in intact and bile- and pancreatic juice-diverted rats. In a first set of experiments, 18: 1 absorption from the gut into lymph and blood was studied by continuous recovery of the mesenteric lymph for 6 h and mesenteric portal venous blood for 1 h. In a second set of experiments, esterification processes were investigated by study of the mucosal distribution of labelled lipids and by mono- and diacylglycerol acyltransferase (EC 2.3.1.22 and EC 2.3.1.20 respectively) specific activities. In the bile- and pancreatic juice-diverted rats the absorption of labelled 18:l into lymph was significantly reduced during the first 3 h of intraluminal infusion of this substrate. In such rats a compensatory absorption of labelled 18: 1 into mesenteric portal blood was not observed. At 6 h after micellar lipid- mixture infusion, the overload of lipids both in free form and as triacylglycerols persisting in the mucosa paralleled the lower acyltransferase specific activities observed in bile- and pancreatic juice-diverted rats. These studies demonstrate the absence of a previously proposed compensatory absorption of 18: 1 into portal blood when absorption into lymph is impaired by an inadequate supply of bile and pancreatic juice.
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Johnson IT. The Influence of Dietary Fibre on Lipid Digestion and Absorption. DIETARY FIBRE — A COMPONENT OF FOOD 1992. [DOI: 10.1007/978-1-4471-1928-9_9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Abstract
An in vivo approach was taken to examine fatty acid esterification in adipose tissue using a coconut oil-enriched diet. Rats were fed a diet containing coconut oil (50% lauric acid) for six weeks. Triacylglycerols from perirenal adipose tissue were fractionated by silver nitrate-thin layer chromatography and, then, preparative gas chromatography. The distribution of 169 triacylglycerol types accounting for 97% of total triacylglycerols was determined. There was evidence for a very high content of mixed triacylglycerols composed of intermediate (12:0 and 14:0) and long acyl moieties. No significant differences were observed between the experimental distribution of triacylglycerol types and the random distribution, calculated from the total fatty acid composition. This indicated that most long chain triacylglycerols stored before coconut oil feeding would have been rearranged after the six weeks of coconut oil feeding. The experimental proportion of trilauroylglycerol reached 2%, as expected from its random proportion, and the proportions of dilauroylacylglycerols were slightly higher than the random values. Present results were compared with those previously obtained from triacylglycerols of adipose tissue of rats fed a low-fat standard diet. From our results and those of other authors, it is suggested that lauric acid is a good substrate for sn-glycero-3-phosphate acyltransferase and diacylglycerol acyltransferase in rat adipose tissue.
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Affiliation(s)
- M Bugaut
- Laboratoire de Physiologie Animale et de la Nutrition, Faculté des Sciences Mirande, Dijon, France
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Nelson GJ, Ackman RG. Absorption and transport of fat in mammals with emphasis on n-3 polyunsaturated fatty acids. Lipids 1988; 23:1005-14. [PMID: 3070250 DOI: 10.1007/bf02535644] [Citation(s) in RCA: 88] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The current state of knowledge concerning the absorption and transport of dietary fat with emphasis on long-chain polyunsaturated n-3 fatty acids in mammals is reviewed. It is apparent that long-chain polyunsaturated n-3 fatty acids, either as free acids or as part of triglycerides, are readily absorbed in the gut and transported by the circulatory system. Indeed, it would appear that long-chain polyunsaturated n-3 fatty acids are digested, absorbed and transported similarly to other long-chain fatty acids with only minor variations, although there is much that is still not understood about these processes. The main unresolved issues in the area of the absorption and transport of long-chain polyunsaturated n-3 fatty acids appear to be: 1) If they, when located in the 2-position of triglycerides, have unique metabolic pathways; and 2) whether the unnatural forms, i.e., methyl or ethyl ester derivatives, are suitable vehicles for administration as dietary supplements. The effect in man of dietary, long-chain polyunsaturated n-3 fatty acids on blood serum lipid and lipoprotein levels, particularly the low density lipoproteins, remains controversial, except for the well-documented reduction in serum triglyceride levels. Also, there is uncertainty regarding their distribution and metabolism in tissues. Finally, if the consumption of long-chain polyunsaturated n-3 fatty acids has beneficial health consequences, what is the appropriate therapeutic dose? In view of these important, unresolved issues and uncertainties, it would seem prudent to direct additional research toward a better understanding of the overall process by which fat is digested, absorbed and transported.
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Affiliation(s)
- G J Nelson
- Biochemistry Research Unit, ARS, U.S. Dept. of Agriculture, San Francisco, CA 94129
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