Role of bile salts in fat malabsorption of premature infants

Signer, E; Murphy, Gérard M.; Edkins, Susan; Anderson, Charlotte M.

doi:10.1136/adc.49.3.174

Cited by 94 publications

(48 citation statements)

References 21 publications

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“…From the present study we cannot conclude which of these processes is responsible for the observed correlation between efficacy of fat absorption and intestinal capability to take up LCFA. However, the bile and bile salt compositions have been reported to change during development, both in preterm and term neonates (2,25,27,28), which could be related to the presently obtained results. To elucidate the possible rate-limiting role of biliary LCFA solubilization in a similarly functional study, longitudinal investigations of bile composition in relation to the capability of LCFA uptake would be informative.…”

Section: Discussionsupporting

confidence: 68%

“…At the neonatal age, and particularly in the case of prematurity, a considerable part of dietary fat is not absorbed from the intestine, but is excreted via the feces (2)(3)(4)(5). Fat absorption involves digestion, requiring lipolysis by lipolytic enzymes, and the subsequent intestinal absorption of the hydrolyzed fatty acids and monoacylglycerols (6).…”

mentioning

confidence: 99%

“…In contrast to medium-chain fatty acids, LCFA are almost insoluble in water and heavily depend on solubilization, mainly by bile components, for their efficient transport through the aqueous phase of the small intestine (24). Several studies suggest that neonatal bile formation (in particular, intestinal bile salt concentration) is still insufficient for efficient and complete solubilization of LCFA (2,(25)(26)(27)(28). At present, it is not known whether the translocation of LCFA across the small intestinal membrane or the intestinal capacity to assemble and secrete chylomicrons is rate-limiting in neonatal fat absorption.…”

mentioning

confidence: 99%

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Functional Development of Fat Absorption in Term and Preterm Neonates Strongly Correlates with Ability to Absorb Long-Chain Fatty Acids from Intestinal Lumen

Rings

Minich²,

Vonk³

et al. 2002

Pediatr Res

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Our goal for this study was to determine whether the maturation of fat absorption in neonatal life is functionally related to an increased ability to hydrolyze dietary fat, to absorb long-chain fatty acids, or to do both. In 16 preterm and in eight term neonates, the intestinal ability to hydrolyze triacylglycerols and the capacity to absorb long-chain fatty acids were determined at several times between birth and 5 mo after the term age. These processes were compared with the percentage of fat absorption (formula-fed infants) or with fecal fat excretion (breast-fed infants). The functional capacity to digest triacylglycerols and to absorb the lipolytic products was evaluated by measuring serum concentrations of the lipolytic product [1-13 C]palmitate after the enteral administration of tri-1-13 C palmitoyl-glycerol. Longchain fatty acids absorption (i.e. independent of lipolysis) was determined by measuring serum concentrations of [1-13 C]stearate after its enteral administration. The efficacy of fat absorption increased in preterm infants (formula-fed) from 91.2 Ϯ 1.1% (mean Ϯ SEM) at 32. Efficient absorption of fat from the diet is important for energy supply, growth, and development, especially during development (1). At the neonatal age, and particularly in the case of prematurity, a considerable part of dietary fat is not absorbed from the intestine, but is excreted via the feces (2-5). Fat absorption involves digestion, requiring lipolysis by lipolytic enzymes, and the subsequent intestinal absorption of the hydrolyzed fatty acids and monoacylglycerols (6). The uptake of lipolytic products encompasses intraluminal solubilization of lipolytic products, their subsequent translocation across the small intestine, and their incorporation into chylomicrons that are subsequently secreted into the lymph (7). The importance and relative contribution of incomplete digestion and a decreased ability for fatty acid absorption to the causes of increased fecal fat loss during (preterm) infancy is only partly understood. Several studies suggest that lipolysis of fats could be the rate-limiting step in (preterm) neonatal dietary fat absorption. In the human gastrointestinal system several lipases are active on dietary triacylglycerols: gastric lipase (8, 9), pancreatic (colipase-dependent) lipase (10, 11), and bile salt-stimulated lipase (12). Several investigators have demonstrated a decreased intraduodenal concentration of both pan-

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Section: Discussionsupporting

confidence: 68%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Functional Development of Fat Absorption in Term and Preterm Neonates Strongly Correlates with Ability to Absorb Long-Chain Fatty Acids from Intestinal Lumen

Rings

Minich²,

Vonk³

et al. 2002

Pediatr Res

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“…One likely explanation is that there was a limitation on nutrient absorption, although secondary influences on caloric utilization cannot be excluded. Since intraluminal bile acid concentrations correlate directly with the efficiency of fat absorption, 34 an induced abnormality in bile acid solubilization of lipid to sustain fat digestion could lead to caloric loss in the stool. Heaton 35 has reviewed the physiological obstacles to energy recovery resulting from dietary fiber in his proposal that dietary fiber may play a role in the prevention of obesity.…”

mentioning

confidence: 99%

Dietary fiber and lipoprotein metabolism in the genetically obese Zucker rat.

Wilson¹,

S²,

Eaton³

1984

Arteriosclerosis

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The present investigation was designed to examine the influence of dietary fibers with differing soluble fiber compositions upon the metabolism of lipids in a hyperlipemic animal model, the Zucker fatty rat. The response to fiber was examined using a diet supplemented with cellulose, oat bran, or pectin which have a soluble/insoluble fiber ratio of 0:100, 33=66, and 100=0, respectively. These fibers provided 10% of the total diet weight; the control diet contained no fiber. A rapid increase in plasma triglyceride concentration was observed in all animals given fiber-supplemented diets in correlation with the increased carbohydrate content of the defined diets relative to the prestudy diets. This increase in plasma triglyceride was due to increased production of triglycerides with no change in the rates of clearance. The plasma total cholesterol levels were relatively constant on all diets. However, after 7 weeks on the pectinsupplemented diet, rats showed a 39% elevation in HDL and a 44% reduction in LDL concentration. This diet also resulted in reduced weight gain, in spite of a caloric intake equivalent to the control diets. Our data suggest that the ability of dietary fiber to alter plasma lipoproteins might be predictable from the soluble fiber composition or the pectin content of a given dietary fiber in this model of genetic endogenous hyperlipemia. (Arteriosclerosis

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“…The combined action of pancreatic lipase and bile salt-stimulated lipase gives such complete hydrolysis. The physiologic relevance of this is supported by the observation of Signer et al (29) who found no correlation between fat absorption and intraduodenal bile salt levels in premature infants fed human milk whereas there was a strong such correlation when the infants were fed cow's milk based formula.…”

Section: \ mentioning

confidence: 75%

Digestion of Human Milk Lipids: Physiologic Significance of sn-2 Monoacylglycerol Hydrolysis by Bile Salt-Stimulated Lipase

Hernell

Bläckberg

1982

Pediatr Res

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SummaryThe bile salt-stimulated lipase secreted with human milk was found to be devoid of positional specificity, i.e., it hydrolyzed emulsified triacylglycerols to glycerol and fatty acids. It also hydrolyzed micellar sn-2 monoacylglycerols. This is in contrast to pancreatic lipase which has a pronounced preferrance for hydrolysis of sn-1 and sn-3 ester bonds. When the two enzymes were operating together, as in the intestine of the infant fed raw human milk, the sn-2 monoacylglycerols formed by pancreatic lipase served as an excellent substrate for bile salt-stimulated lipase. Thus, the end products of triacylglycerol hydrolysis became glycerol and fatty acids and not sn-2 monoacylglycerol and fatty acids. The bile salt-stimulated lipase also catalyzed incorporation of fatty acids into acylglycerols to a much lesser extent than did pancreatic lipase. Together these two effects of bile salt-stimulated lipase have a promoting effect on the overall process of intraluminal lipolysis.In newborn infants, with low intraduodenal bile salt concentrations, glycerol and fatty acids also should be more readily absorbed than monoacylglycerol and fatty acids. Thus, by serving as a complement to pancreatic lipase, bile salt-stimulated lipase can ensure efficient utilization of milk lipids also in infants with immature endogenous mechanisms for fat digestion and absorption.In the healthy human adult, digestion and absorption of dietary fat is almost complete, i.e., at least 95% of consumed fat is absorbed. The corresponding figures reported for newborn infants vary widely but, are especially for preterm infants often considerably lower (9,11,12,30,34,38). In these infants an impaired overall process of fat digestion and absorption has been attributed mainly to low intraduodenal concentrations of pancreatic lipase (15, 27, 39) and bile salts (8,26,35).Human milk contains a potent lipase, the bile salt-stimulated lipase, which supplement the low pancreatic lipase concentrations (16, for review see 18,19). This can explain why human milk fat is more efficiently utilized than fat from formulas based on cow's milk (12,23,37). Strong evidence that the bile salt-stimulated lipase has an important role in the digestion of milk lipids in the newborn comes from the recent observation that heat-treatment of human milk reduces fat absorption by approximately one third in preterm infants (1,38). Previous studies have established that this lipase contributes to hydrolysis of milk triacylglycerols and vitamin A esters (14,17). An additional, perhaps more important role of this lipase, might be to hydrolyze the monoacylglycerols generated by pancreatic lipase. Due to its positional specificity, pancreatic lipase hydrolyzes only two of the three ester bonds in a triacylglycerol molecule (7,24). Furthermore, this enzyme catalyzes not only hydrolysis but also esterification (4). Therefore, it soon reaches an equilibrium state where the rate of formation of di-and triacylglycerols by acylation of monoacylglycerols equals the rate of hydrolysis. F...

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Role of bile salts in fat malabsorption of premature infants

Cited by 94 publications

References 21 publications

Functional Development of Fat Absorption in Term and Preterm Neonates Strongly Correlates with Ability to Absorb Long-Chain Fatty Acids from Intestinal Lumen

Functional Development of Fat Absorption in Term and Preterm Neonates Strongly Correlates with Ability to Absorb Long-Chain Fatty Acids from Intestinal Lumen

Dietary fiber and lipoprotein metabolism in the genetically obese Zucker rat.

Digestion of Human Milk Lipids: Physiologic Significance of sn-2 Monoacylglycerol Hydrolysis by Bile Salt-Stimulated Lipase

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