A KRONDL’s research while affiliated with National Museum, Prague, Czech Republic and other places

Medium chain triglycerides (MCT) were used in the treatment of 20 patients with malabsorption of different aetiology, mostly after resection of the small intestine. In some of them the effect of substitution of the visible dietary fat by MCT on the nitrogen balance, composition of the faeces (in seven subjects), on the serum levels of esterified fatty acids, cholesterol, vitamin A, beta-carotene (10 subjects) and ketone bodies (3 subjects) was investigated. The patients tolerated MCT well and no deterioration of their condition was observed. On the contrary, in most instances weight increments, a reduced frequency of bowel movements and partial improvement of dyspeptic complaints were recorded. Balance studies revealed a significant reduction of the dry weight of the faeces and faecal fat excretion, a higher water content of the faeces, and in most patients the nitrogen balance improved. During our short-term investigation we did not observe any changes in the scrum levels of esterified fatty acids, cholesterol, vitamin A, beta-carotene and ketone bodies. From the results it is apparent that partial replacement of dietary fat by MCT or supplementation of the diet by liquid formulae containing MCT is suited for the realimentation of patients suffering from malabsorption.

ALANCE STUDIES provide the basic data for the diagnosis of malabsorption states. The most important of these are fat balance studies--the assessment of fecal fat losses in subjects with known dietary intake. Because this examination is very ambitious, it is limited almost entirely to metabolic investigations in specialized departments. In colnrnon diagnostic practice, as a rule, the average fecal f~t loss is assessed after 3 or more days on a free or unrestricted diet; moreover, the complex character of digestive and absorption disorders during malabsorption has stimulated the development of several simpler, more readily available indirect estimations and absorption tests. Accuracy is often sacrificed in the simplification of balance studies, as well as in the development of indirect examination methods. In practice the greatest difficulty is encountered in obtaining a reliable diagnosis of mild, borderline disorders and in the differential diagnosis of different types of malabsorption. Our efforts to simplify the diagnostic procedure but at the same time render it more accurate led us to analyze the results of nitrogen and fat balance studies in patients with malabsorption of different etiologies. In addition to data on fecal fat excretion we also collected data on the daily fecal nitrogen loss, the dry matter content of feces, the amount of feces, and the absolute amount and percentage of water in feces. The object o[ our study was to ascertain whether in steatorrhea a more detailed analysis of feces than the simple measurement of fat losses make the diagnosis more accurate. By comparing the results of analyses in cases of steatorrhea of different etiologies, we wanted to find out whether these analyses are of any importance in terms of the differential diagnosis.

By means of fat and nitrogen balance studies the authors investigated the significance of an increased dietary fat intake (from 80 to 120 g per 24 h) in patients after resection of the small intestine and with malabsorptions of another aetiology. (1) On a fat intake of 80 g per day steatorrhoea was not found in any patient with resection of less than 1 m. Steatorrhoea developed on this intake only in patients with extensive resections. The increase of the fat intake to 120 g per day led to an increased utilization of the ingested fat regardless of the extent and site of resection. In intestinal resections up to 1 m (and gastrectomy) the occurrence of steatorrhoea after a higher fat intake draws attention to a compensated impairment of the digestive and absorptive capacity of the gastrointestinal tract for fat. (2) A higher dietary fat intake in the form of fresh butter was well tolerated by the majority of patients with steatorrhoea, regardless of the aetiology of malabsorption. In all patients a substantial increase of the caloric intake was recorded. The utilization of fat on the higher intake was significantly worse in patients with severe steatorrhoea. The increase of the fat intake did not lead to changes in the faecal nitrogen content and in the nitrogen balance. From the results it is apparent that investigations of faecal fat loss on a normal as well as on an increased dietary fat intake are important for a more accurate diagnosis of a compensated impairment of the digestive and absorptive capacity of the gastrointestinal tract. In more severe malabsorptions it is possible to increase in some instances the caloric intake without exerting an adverse effect on the nitrogen metabolism.