This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Fat malabsorption (steatorrhea) results from impaired digestion or absorption of dietary fats and it can be caused by multiple diseases including cystic fibrosis, chronic pancreatitis, cholestatic liver disease, celiac disease, and inflammatory bowel disease. If untreated, fat malabsorption may result in malnutrition, growth failure, and deficiencies of fat-soluble vitamins A/E/D/K with resultant skin and visual changes, neurologic deficits, osteoporosis/rickets and coagulopathy. Currently the gold standard test to diagnose steatorrhea remains the fat balance study, which is based on the premise that fat intake minus fat output equals fat absorbed. This test is very time consuming as it requires a three to five day stool collection and complete dietary history. These limitations make this test impractical in the clinical setting and stress the need for a facile, accurate test of fat malabsorption. The development of a facile means to quantitative measure fat loss in the stool is urgently needed. Despite previous attempts to develop simpler methods than the 72 hour fecal fat collection method, none have proven to be easier and as reliable as the gold standard. In the current proposal, fat absorption will be measured by assessing stool behenic acid concentration in 'spot stool' samples after giving a standardized dose will predictable correlate with fat absorption assessed using the quantitative measure of fat absorption in the gold standard, the 72 hour fecal fat collection in healthy control adults. The ratio of behenic acid in a 'spot sample' of stool after ingestion of a known quantity of this fatty acid compared to total fatty acids in stool will be measured and compared to the results of absorption using behenic acid as a marker compared to the 'gold standard,' the 72 hour fecal fat collection method when subjects are treated with pancreatic enzymes compared to a period when they are receiving no pancreatic enzyme supplements.
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