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Pathofysiologie en diagnostiek van vetmalabsorptie: nieuwe inzichten

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Tijdschrift voor kindergeneeskunde

Summary

The adequate absorption of dietary fats is of crucial importance for optimal growth and development of children. Certain pathological conditions, such as cystic fibrosis and cholestatic liver disease, are associated with impaired efficiency of dietary fat absorption. Present insights in the (patho)physiological processes involved in intestinal fat (mal)absorption are discussed. The diagnosis of fat malabsorption is conventionally made on the basis of a 72-h fat balance. The execution of the 72-h fat balance in children, however, has been proven to be cumbersome and not always highly reliable. A novel diagnostic development with regard to fat absorption involves the application of stable isotope technologies. In comparison with the 72-h fat balance, new diagnostic tests aim to improve the applicability in children and to obtain better insights into underlying pathophysiological mechanisms of fat malabsorption. Results obtained so far with two new tests, the 13C-mixed triglyceride test and the 13C-palmitate test, in animal models and in pediatric patients are discussed. Application of a combination of stable isotope tests in children with cystic fibrosis has indicated that this type of fat malabsorption is not only due to impaired fat digestion (lipolysis) but also to a decreased intestinal capacity to absorb long-chain fatty acids.

Samenvatting

Adequate opname door de darm van voedingsvetten is belangrijk voor optimale groei en ontwikkeling van kinderen. Een aantal aandoeningen, zoals cystische fibrose en cholestatische leverziekte, is geassocieerd met verminderde efficiëntie van vetabsorptie. In dit artikel worden de huidige inzichten in de (patho)fysiologische processen betrokken bij vet(mal)absorptie besproken. De diagnostiek van vet(mal)absorptie is langdurig beperkt gebleven tot de zogenaamde 72-uursvetbalans, waarvan de correcte uitvoering bij kinderen echter niet eenvoudig is gebleken, leidend tot een aanzienlijk risico op onvoldoende betrouwbare resultaten. Een nieuwe ontwikkeling in de diagnostiek van vetabsorptie betreft het gebruik van stabiele isotooptechnologie. In vergelijking met de 72-uursvetbalans beogen nieuwe diagnostische tests betere toepasbaarheid op de kinderleeftijd en nauwkeuriger inzicht in het pathofysiologisch mechanisme van de vetmalabsorptie. Wij bespreken de tot dusver verkregen resultaten van twee tests, de 13C-mengtriglyceridetest en de 13C-palmitinezuurtest, in proefdiermodellen en bij pediatrische patiënten. Toepassing van een combinatie van stabiele-isotooptests bij kinderen met cystische fibrose heeft het inzicht opgeleverd dat de vetmalabsorptie in deze klinische situatie niet alleen het gevolg is van gestoorde vetsplitsing, maar ook van verminderd vermogen van de darm om langeketenvetzuren op te nemen.

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    H. J. Verkade

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  1. H. J. Verkade
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  2. C. M. A. Bijleveld
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  3. A. Werner
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Dr. Henkjan J. Verkade Instituut voor Lever, Darm en Stofwisselingsziekten, afd. Kindergeneeskunde, Beatrix Kinderkliniek/Academisch Ziekenhuis Groningen.

Correspondent: Dr. H.J. Verkade, afd. Kindergeneeskunde, Research Laboratorium CMC IV, Kamer Y-2115, Academisch Ziekenhuis Groningen, Postbus 30.001, 9700 rb Groningen.

Charles Bijleveld Instituut voor Lever, Darm en Stofwisselingsziekten, afd. Kindergeneeskunde, Beatrix Kinderkliniek/Academisch Ziekenhuis Groningen.

Anniek Werner Instituut voor Lever, Darm en Stofwisselingsziekten, afd. Kindergeneeskunde, Beatrix Kinderkliniek/Academisch Ziekenhuis Groningen.

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Verkade, H.J., Bijleveld, C.M.A. & Werner, A. Pathofysiologie en diagnostiek van vetmalabsorptie: nieuwe inzichten. KIND 68, 45–52 (2000). https://doi.org/10.1007/BF03061281

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