Fecal Fat Excretion Research Articles

Autoimmune pancreatitis associated with anisakis infection

A 67-year-old man with Type 2 diabetes mellitus of seven ears duration presented with persistent epigastric pain of mild ntensity, decompensated diabetes and diarrhoea of 7 months uration; he was afebrile. At physical examination, the epigastric ain increased at palpation. Laboratory values were normal xcept for hyperglycemia, eosinophilia (leucocytes 6.74× 103/ L, osinophils 8.6%) and a total IgE of 206 kU/L (reference limit 100). Autoantibodies were not detectable. Faecal fat excretion as clearly abnormal (12 g/24 h). Computed tomographic scan evealed a small mass on the head of the pancreas; endoscopic ltrasonography confirmed a hypoechogenic pancreatic mass of 3 mm× 12 mm in diameter. The common bile duct and the main ancreatic duct were normal; cytology examination, unfortunately, evealed only rare leukocytes. A surgical exploration was planned ue to the suspicion of pancreatic cancer [1] or the presence of osinophilic autoimmune pancreatitis [2,3]. During the operation, a mall mass in the gastric antrum was also found, a pancreaticoduoenectomy with partial gastrectomy was performed. Histological xamination of the pancreatic resection specimen showed a picture ompatible with autoimmune pancreatitis (presence of small ymphocytes together with duct destructive pancreatitis) (Fig. A). he gross appearance of the gastric specimen showed the presence

Octreotide therapy in dumping syndrome: analysis of long‐term results

Octreotide therapy is effective in controlling severe dumping symptoms during short-term follow-up but little is known about long-term results. To report on the long-term results of patients with severe dumping syndrome treated at the Leiden University Medical Center with subcutaneous or depot intramuscular (long-acting release) octreotide. Follow-up of 34 patients with severe dumping syndrome refractory to other therapeutic measures treated between 1987 and 2005 with octreotide subcutaneous/long-acting release. At regular intervals symptoms, quality of life, weight, faecal fat excretion and gallstone formation were evaluated. All patients had excellent initial relief of symptoms during octreotide subcutaneous therapy. However, during follow-up 16 patients stopped therapy because of side effects (n = 9) or loss of efficacy (n = 7). Four patients died. Fourteen patients (41%) remain using octreotide (follow-up 93 +/- 15 months), seven are on octreotide subcutaneous and seven on octreotide long-acting release. Patients with severe dumping (both early and late) do better on subcutaneous than long-acting release despite the inconvenience of frequent injections. Dumping symptoms are reduced by 50% even in long-term users. Body weight continues to increase during therapy despite more pronounced steatorrhoea. The long-term the efficacy of octreotide is much less favourable compared with short-term treatment.

Efficacy of Lower Than Standard Doses of Pancreatic Enzyme Supplementation Therapy During Acid Inhibition in Patients With Pancreatic Exocrine Insufficiency

To compare, during strong acid inhibition with omeprazole, the effect of 2 different doses of an enteric-coated pancreatic enzyme preparation on fecal fat excretion and abdominal symptoms in patients with exocrine insufficiency due to chronic pancreatitis (CP). Treatment with pancreatic enzymes reduces fecal fat excretion in patients with CP but is rather unsuccessful due to irreversible lipase inactivation at pH below 4. Sixteen patients with CP (3 women, 13 men; age 53+/-3 y) participated in this randomized double blind 2-way cross over study. Fecal fat excretion and fat intake were measured and abdominal symptoms (visual analog scales) were scored during a 2 weeks control period, during omeprazole 60 mg+pancreatic enzymes 10,000 Fédération Internationale Pharmaceutique IU lipase tid (treatment A) for 2 weeks and during omeprazole 60 mg+pancreatic enzymes, 20,000 Fédération Internationale Pharmaceutique IU lipase tid (treatment B) for 2 weeks. During acid inhibition with enzyme supplementation fecal fat excretion was significantly (P<0.01) reduced compared with control: 18+/-7 and 18+/-5 g/24 h versus 36+/-8 g/24 h for treatment A, B, and control, respectively. Abdominal symptom score and general well being improved significantly (P<0.05) during treatments A and B versus control. No differences in fat excretion or symptoms scores between treatments A and B were observed. During strong acid inhibition, lower than recommended oral doses of pancreatic enzymes are therapeutically effective with respect to fat absorption and symptom reduction.

Treatment of Diarrhea in Common Variable Immunodeficiency

Common Variable Immunodeficiency Disorder (CVID) is an immunological disease that can present with GI issues including chronic diarrhea, abdominal pain, and protein losing enteropathy. The mainstay of treatment, IVIG infusion, usually does not improve GI symptoms. Systemic steroids have been used but are associated with significant side effects. Enteric coated budesonide is a poorly absorbed oral corticosteroid used to treat Crohn disease. It is locally acting and has high first pass metabolism resulting in greatly reduced systemic exposure compared to traditional steroids. We report a patient with CVID and chronic diarrhea who significantly improved with budesonide. A 47 YOF with CVID associated diarrhea, abdominal pain, and bloating for several years had an exhaustive evaluation of her GI symptoms which was unrevealing. She had failed treatments with exclusion diets and loperamide. Prednisone provided some improvement of her GI symptoms. At the advice of her immunologist, she attempted a course with budesonide which significantly improved her GI symptoms. Given the absence of literature on this approach, a systematic evaluation of budesonide on this patient's GI symptoms was undertaken. The patient weaned budesonide over 1 week. 24 hour stool weight, fecal fat excretion, stool frequency, stool consistency (Bristol Stool Form Scale), abdominal pain, bloating, and serum IgG levels were assessed 4 days after complete cessation of budesonide and again 14 days after restarting budesonde (3mg tid). Diarrhea, abd pain and bloating recurred within 2 days of discontinuing budesonide. All parameters measured improved upon reinitiating budesonide (table 1). No significant side effects were observed with budesonide.Table 1To our knowledge, this is the first report of a patient with CVID-related chronic diarrhea to be successfully treated with oral budesonide. Further, steatorrhea, abd pain and bloating also improved. Perhaps most interesting, serum IgG levels significantly increased with budesonide. This novel observation may provide clinicans with an effective and safe treatment option in this difficult group of patients.

Nonabsorbable Dietary Fat Enhances Disposal of 2,2‘,4,4‘-Tetrabromodiphenyl Ether in Rats through Interruption of Enterohepatic Circulation

Polybrominated diphenyl ethers are lipophilic persistent organic pollutants (POPs), which accumulate in the environment, leading to human exposure. The compounds exert a negative impact on human health. Strategies to prevent or diminish their accumulation in humans are required. We investigated in rats whether the disposal rate of 14C-labeled tetrabromodiphenyl ether (BDE-47) could be enhanced by increasing fecal fat excretion through dietary treatment with nonabsorbable fat (sucrose polyester, SPE). As compared to control rats, SPE treatment increased fecal excretion rates of fat (+188%, p < 0.05) and 14C-BDE-47 (+291%, p < 0.05). On the basis of biliary secretion and fecal excretion rates of 14C-BDE-47, SPE effectively inhibited the enterohepatic circulation of 14C-BDE-47. In conclusion, dietary supplementation of nonabsorbable fat can enhance excretion of hydrophobic POPs by interruption of their enterohepatic circulation. Our data indicate that this strategy could decrease concentrations of hydrophobic POPs in the human body and thereby their impact on human health.

An Enteric-Coated High-Buffered Pancrelipase Reduces Steatorrhea in Patients with Cystic Fibrosis: A Prospective, Randomized Study

Objective Enteric-coated (EC) high-buffered (2.5 mEq [2.5 mmol] bicarbonate per capsule) pancrelipase microsphere enzymes were compared to EC-nonbuffered pancreatic enzymes for efficacy in reducing steatorrhea in patients with cystic fibrosis. Design Prospective, randomized, controlled trial using a crossover design with each subject as his/her own control. Subjects/Setting Eighteen subjects with cystic fibrosis, who had pancreatic insufficiency and required large enzyme doses, were studied over two consecutive 7-day treatment periods. Intervention Each 7-day period consisted of 3 days at home followed by 4 days in a general clinical research center for careful control of diets, enzyme lipase doses (given at approximately 50% of the subject’s usual lipase dose), and carmine red-labeled stool collections for 72-hour fecal fat balance studies. Main Outcome Measure Fecal fat excretion. Statistical Analyses Performed Differences in fat excretion, when each subject received EC–high-buffered pancrelipase vs EC-nonbuffered enzymes, were compared using linear modeling. Results Mean fat excretion decreased significantly in each subject during periods when given EC–high-buffered pancrelipase compared with periods when given EC-nonbuffered enzymes (fat excretion 18.2% vs 24.9% or fat absorption 81.8% vs 75.1%, respectively; P=0.01). Thirteen of 18 subjects (72%) excreted less fat when receiving EC–high-buffered pancrelipase whereas 10 (56%) decreased fat excretion by more than 5%, and five subjects did not respond. Conclusions EC–high-buffered pancrelipase decreased fat excretion, symbolizing improved fat absorption, when compared with EC-nonbuffered pancreatic enzymes given at equivalent, reduced (approximately 50% of usual) lipase doses in nourished subjects with cystic fibrosis and mild pulmonary disease.

Mechanism of hypolipidemic effect of crocin in rats: Crocin inhibits pancreatic lipase

The hypolipidemic mechanism of crocin, an active ingredient in Gardenia jasminoides Ellis and Crocus sativus L, was examined in rats. In diet-induced hyperlipidemic rats, a 10-day treatment with crocin significantly reduced serum triglyceride, total cholesterol, low density lipoprotein (LDL) cholesterol and very low density lipoprotein (VLDL) cholesterol level in the daily dose range of 25 to 100 mg/kg. Results of the modified fat-loading method indicated that crocin inhibited the absorption of fat and cholesterol and this inhibition is closely related to the hydrolysis of fat. In addition, the modified fat-balance method demonstrated that crocin increased the fecal excretion of fat and cholesterol in rats, but had no influence on the elimination of bile acids. The results of the in situ loop method and enzyme assay indicated that crocin could not directly block the absorption of cholesterol from rat jejunum but could selectively inhibit the activity of pancreatic lipase as a competitive inhibitor. These findings suggest that crocin yielded its hypolipidemic effect by inhibiting pancreatic lipase, leading to the malabsorption of fat and cholesterol.

Body fat loss achieved by stimulation of thermogenesis by a combination of bioactive food ingredients: a placebo-controlled, double-blind 8-week intervention in obese subjects

A combination of tyrosine, capsaicin, catechines and caffeine may stimulate the sympathetic nervous system and promote satiety, lipolysis and thermogenesis. In addition, dietary calcium may increase fecal fat excretion. To investigate the acute and subchronic effect of a supplement containing the above mentioned agents or placebo taken t.i.d on thermogenesis, body fat loss and fecal fat excretion. In total, 80 overweight-obese subjects ((body mass index) 31.2+/-2.5 kg/m(2), mean+/-s.d.) underwent an initial 4-week hypocaloric diet (3.4 MJ/day). Those who lost>4% body weight were instructed to consume a hypocaloric diet (-1.3 MJ/day) and were randomized to receive either placebo (n=23) or bioactive supplement (n=57) in a double-blind, 8-week intervention. The thermogenic effect of the compound was tested at the first and last day of intervention, and blood pressure, heart rate, body weight and composition were assessed. Weight loss during the induction phase was 6.8+/-1.9 kg. At the first exposure the thermogenic effect of the bioactive supplement exceeded that of placebo by 87.3 kJ/4 h (95%CI: 50.9;123.7, P=0.005) and after 8 weeks this effect was sustained (85.5 kJ/4 h (47.6;123.4), P=0.03). Body fat mass decreased more in the supplement group by 0.9 kg (0.5; 1.3) compared with placebo (P<0.05). The bioactive supplement had no effect on fecal fat excretion, blood pressure or heart rate. The bioactive supplement increased 4-h thermogenesis by 90 kJ more than placebo, and the effect was maintained after 8 weeks and accompanied by a slight reduction in fat mass. These bioactive components may support weight maintenance after a hypocaloric diet.

Effect of dietary calcium and lactose maldigestion on fecal fat excretion during energy restriction in obese adults

Effect of dietary calcium and lactose maldigestion on fecal fat excretion during energy restriction in obese adults

Does Pancreatic Elastase-1 in Stools Predict Steatorrhea in Type 1 Diabetes?

Areduction of exocrine pancreas function frequently occurs in type 1 diabetes (1), and its detection has been made easy by measurement of fecal pancreatic elastase-1 (PE-1) (2,3). We recently observed that PE-1 correlates in these patients with poor blood glucose control, diabetes duration, and residual β-cell function (4). A possible consequence of severe pancreatic insufficiency is steatorrhea, defined as a daily fecal fat excretion (FFE) >6 (1) or >7 (5) g/day for subjects consuming 100 g of fat per day (1,5,6). Testing FFE requires multiple daily stool collections (6) and is not routinely feasible in asymptomatic subjects, being poorly accepted by patients and disliked by laboratory technicians. We considered here the hypothesis that low PE-1 identifies patients to be submitted to FFE measurement for steatorrhea detection. We studied, with the approval of the ethical committee of our institution and the subjects’ informed consent, 66 consecutive type 1 diabetic subjects in regular follow-up at our diabetes clinic without history or symptoms of gastrointestinal disease and negative for anti-transglutaminase, anti-gliadin, and anti-endomysium antibodies checked to exclude celiac disease. Their clinical features were 32 men and 34 women aged (means ± SD) 36.7 ± 12.1 years, age at diagnosis 22.7 ± 13.6 years, diabetes duration 13.9 ± 9.7 years, BMI 24.6 ± 3.7 kg/m2, fasting C-peptide 0.21 ± 0.32 ng/ml (radioimmunoassay; Adaltis, Bologna, Italy), Diabetes Control and Complications Trial–aligned HbA1c 8.4 ± 1.4% (high-performance liquid chromatography, Bio-Rad Variant II Total GHb Program; Bio-Rad Laboratories, Munchen, Germany; calibrated to the Diabetes Control and Complications Trial through the U.S. National Glycohemoglobin Standardized Protocol), and daily albumin excretion rate (AER) 35.3 ± 63.7 μg/min (nephelometry; Beckman, Milan, Italy). A total of 49 subjects were normoalbuminuric, 15 were micro- and 2 macroalbuminuric, 45 presented no diabetic retinopathy, 14 …

Measurement of faecal fat excretion: an evaluation of attitudes and practices of Australian gastroenterologists

Although faecal fat excretion over 72 h is the gold standard for quantifying fat malabsorption, there has been a push from chemical pathology laboratories to discontinue this test, arguing that it is unreliable and of limited clinical value. To assess attitudes, knowledge and practices of Australian gastroenterologists in relation to the test and to gauge opinion as to whether it should remain available. A self-administered questionnaire was developed to assess attitudes towards, patterns of use and understanding of 72-h faecal fat collections. This was posted to all members of the Gastroenterological Society of Australia. Of 429 eligible gastroenterologists, 124 (29%) responded. Eighty-two per cent utilized the test; 62% at least once per year. Main indications were suspected steatorrhoea (55%), unexplained chronic diarrhoea (39%) or weight loss (29%). Thirty-eight per cent ordered the test to determine stool volume. Only 26% attempted to appropriately fat load patients and approximately half did not recognize the potential influence of medications and stool volume. This was also reflected in poor interpretation of results in specific clinical scenarios. Of those who use the test at least once per year, 97% wanted its continued availability and 51% felt their practice would be significantly affected if the test was discontinued. Although continued availability of 72-h faecal fat estimation is supported by many Australian gastroenterologists, the test appears to be often performed and interpreted suboptimally. Rather than discard the test, efforts should more appropriately be directed to improving baseline knowledge to ensure its optimal performance and interpretation.

Consumption of Pork-Liver Protein Hydrolysate Reduces Body Fat in Otsuka Long-Evans Tokushima Fatty Rats by Suppressing Hepatic Lipogenesis

This study was performed to examine the effect of consumption of pork-liver protein hydrolysate (PLH) on body fat accumulation in Otsuka Long-Evans Tokushima Fatty (OLETF) rats as a non-insulin-dependent diabetes mellitus model and in Long-Evans Tokushima Otsuka (LETO) rats as a control. Male 20-week-old OLETF and LETO rats were pair-fed either PLH or casein containing diet for 14 weeks. In the OLETF rats, dietary PLH significantly reduced the growth and weight of fat pad including perirenal and epididymal adipose tissues. Consumption of PLH markedly suppressed hepatic activities of lipogenesis enzymes such as glucose-6-phosphate dehydrogenase and fatty acid synthase and slightly elevated fecal excretion of total fat. In the LETO rats, growth and adipose tissue weight were unaffected by dietary treatment. The results suggest that PLH is a novel ingredient suppressing body fat in genetically obese rats by reducing lipogenesis.

Normal pancreatic secretion in children with progressive familial intrahepatic cholestasis type 1

Objective. Progressive familial intrahepatic cholestasis type 1 (PFIC1) is a rare, autosomal, recessive, inherited disease resulting from mutations in the ATP8B1 gene which is expressed at high levels in the small intestine and pancreas and at lower levels in the liver. Given this expression pattern, patients might be expected to have a pancreatic phenotype. Although pancreatitis and steatorrhea have been reported in patients with PFIC1, the available data on pancreatic function are not fully convincing. Therefore, the objective of this study was to assess exocrine pancreatic function in patients with PFIC1. Material and methods. Three subjects with a diagnosis of PFIC1 were included in the study. The diagnosis was confirmed by molecular analysis of ATP8B1. Prior to surgical treatment (biliary diversion), two patients had steatorrhea and in the third patient, a borderline value for fecal fat excretion was documented. In one patient, liver transplantation also was subsequently performed. Exocrine pancreatic secretion was assessed by the use of fecal elastase-1 and chymotrypsin tests. Fecal lipase concentrations were determined in order to exclude isolated lipase deficiency. Other typical diagnostic procedures were performed annually. Results. The results of the fecal tests were within the normal range. None of the three patients experienced any episodes that could be related to acute or chronic pancreatitis. Laboratory tests including serum amylase and lipase tests were always normal. Abdominal ultrasonography findings did not show any pancreatic pathology. Conclusions. Pancreatic secretion in the study patients with progressive familial intrahepatic cholestasis type 1 was normal. The observed steatorrhea was not related to pancreatic insufficiency.

The anti-obesity agent Orlistat is associated to increase in colonic preneoplastic markers in rats treated with a chemical carcinogen

Orlistat is an anti-obesity agent that increases the fecal fat excretion, which promotes colon carcinogenesis. Therefore, the present study was designed to verify the effects of Orlistat on the formation of rat colonic aberrant crypt foci (ACF) and cell proliferation evaluated by the PCNA method. Male Wistar rats received either a standard diet or a high fat diet (HFD), supplemented or not with Orlistat (200 mg/kg chow) and two doses of the carcinogen dimethyl-hydrazine (25 mg/Kg). After 30 days, Orlistat was associated to a significant increase in the number of colonic ACFs and cell proliferation in DMH-treated animals, independently of the HFD.

Effects of Arachis hypogaea nutshell extract on lipid metabolic enzymes and obesity parameters

The aim of the present study was to assess the effects of peanut ( Arachis hypogaea L.) shell extracts (PSE) on lipases and to evaluate its potential development for the treatment of obesity. The peanut shells were extracted in 95% ethanol, and the extracts were screened for inhibitory effects on pancreatic lipase (PL) and lipoprotein lipase (LPL) activities as well as on lipolysis of 3T3-L1 adipocytes. We also examined in vivo whether PSE could prevent the body weight gain induced by feeding a high-fat diet to male Wistar rats for 12 weeks. PSE inhibits a number of lipases, including PL, LPL and, possibly, hormone sensitive lipase (HSL). PSE-treated Wistar rats showed increased fecal lipid excretion respect to the control group. Body weight and body weight gain, and liver size, were significantly lower in rats fed the high-fat diet with 1% of PSE ( w : w diet) than in those fed the high-fat diet alone. The rats treated with PSE showed reduced triacylglycerol content in the liver, as well as the serum glucose and insulin. The inhibitory activity of PSE on the lipid metabolic enzymes and the increase in fecal fat excretion suggests that PSE might be useful as a treatment to reduce the dietary fat absorption. The observed reduction in intracellular lipolytic activity of cultured 3T3-L1 adipocytes may reduce the levels of circulating free fatty acids. The observed effects are likely induced by more than one bioactive component of PSE. The PSE actions may, at least in part, be attributed to the inhibition of fat absorption in the digestive tract and the reduction of the adipocyte lipolysis.

Postoperative management of patients with total exocrine pancreatic insufficiency

The occurrence of maldigestion and malnutrition was studied in 14 patients who had undergone pancreaticoduodenectomy and occlusion of the Wirsung duct with Neoprene. Before discharge patients were put on a 70 g/day dietary fat intake. Mean faecal fat excretion was 32.9 g/day without enzyme replacement and fell to 14.2 g/day with pancrelipase supplementation. At discharge all patients were underweight (88 per cent of the usual mean body-weight) and nine patients showed alteration in laboratory nutritional parameters. At the time of discharge a low-fat diet (50 g/day) was prescribed. Six months after surgery, mean faecal fat excretion decreased further to 8.3 g/day (P less than 0.01) and all patients but one gained weight, reaching 93 per cent of the usual mean body-weight with normalized nutritional parameters. Our data show that the combination of enzyme replacement therapy and low-fat diet allows good correction of steatorrhoea and a significant improvement in nutritional status.

Cholesterol Metabolism Is Affected by Calcium Phosphate Supplementation in Humans

Dietary calcium and phosphate precipitate in the small intestine to form insoluble amorphous calcium phosphate (ACP). The ability of ACP to bind and inactivate luminal bile acids might have an effect on cholesterol metabolism. To test this hypothesis, a placebo-controlled, double-blind, crossover study with pentacalcium hydroxy-triphosphate supplementation (CaP; 1.0 g elemental calcium) was conducted in 31 young healthy volunteers. The CaP was incorporated into bread. Serum cholesterol concentrations were lower after 4 wk of supplementation than after 4 wk of placebo (4.36 vs. 4.60 mmol/L; P = 0.008). Serum LDL cholesterol and the ratio of LDL:HDL cholesterol also tended to be lower after CaP supplementation than after placebo (-5.6%, P = 0.083 and -5.4%, P < 0.062, respectively). The participants' fat and cholesterol intakes and fecal fat excretion did not differ in the 2 periods. Although the analysis of fecal samples showed no difference in the excretion of total neutral sterols (sum of cholesterol and its transformation products), the excretion of cholesterol itself increased (9.64 vs. 5.80 micromol/g dry matter; P = 0.025; n = 25), whereas the excretion of the metabolite coprostanol decreased (18.5 vs. 21.0 mumol/g dry matter; P = 0.025; n = 25) in the CaP period. Bile acid excretion increased during the CaP period compared with the placebo period (25.4 vs. 22.9 micromol/g dry matter; P = 0.003). The observed beneficial effects on cholesterol metabolism are not the result of an increased excretion of cholesterol, but might be explained by an increased bile acid excretion and a subsequent regeneration of bile acids from endogenous cholesterol in the liver.

Low-Dose Gluten Challenge in Celiac Sprue: Malabsorptive and Antibody Responses

Undiagnosed patients with symptoms of celiac sprue often present to physicians after establishing dietary gluten exclusion. Although they must resume a gluten-containing diet for evaluation, there are no guidelines regarding duration of the gluten challenge, gluten dose, or monitoring parameters. We investigated the effects of a short-term gluten challenge in asymptomatic treated adult celiac patients on intestinal absorption and celiac antibody tests. Eight adult asymptomatic celiac patients consumed either 5 or 10 g of partially hydrolyzed gluten per day in an orange juice mixture for 21 days while maintaining their usual gluten-free diet. A symptom questionnaire, serum antibodies (antigliadin immunoglobulin [Ig]A and antitransglutaminase IgA and IgG), D-xylose urine excretion test, and 72-hour quantitative fecal fat test were monitored. Two patients (25%) had at least 1 abnormal celiac antibody test at baseline. There was no increase in antibodies during gluten exposure compared with baseline for any of the patients (P > .05). At baseline, 1 patient had abnormal urine xylose excretion, and 3 patients had abnormal fecal fat values. At day 15 of gluten challenge, all patients had reduced xylose absorption compared with baseline (P = .0019), and 5 of 8 participants (63%) reduced their xylose excretion to the abnormal range. Seven of 8 patients (88%) had increased fecal fat excretion at day 15 (P = .026), and 6 of these (75%) had steatorrhea by day 15. Short-term gluten challenge in asymptomatic adult celiac patients produces carbohydrate and fat malabsorption but does not increase transglutaminase and antigliadin antibody titers.

Influence of a fiber mixture on serum and liver lipids and on fecal fat excretion in rats

Male Sprague-Dawley rats (8 per group) were fed a modified AIN-76A diet containing either 10% cellulose or 10% of a proprietary fiber mixture for 21 days. Weight gain and liver weight were similar in the 2 groups but feed efficiency was higher in the test group. Serum cholesterol and triglycerides were lowered by 11% and 15%, respectively, by the test diet. Liver cholesterol was lowered significantly in the fiber-fed rats whereas liver triglycerides were elevated. Twenty-four–hour fecal collections were made on days 12 and 19. The weight of feces was unaffected by the test diet, but water content and fecal fat were increased by 27% and 44% and by 99% and 100%, respectively, on days 12 and 19. The amount of Liebermann-Burchard–positive material in the feces was significantly higher in rats fed the test material. The increases on days 12 and 19 were 139% and 105%, respectively.

Dietary Calcium Intake and Obesity

Obesity is increasing in the United States in epidemic proportions. Epidemiologic data suggest that people with high calcium intake have a lower prevalence of overweight, obesity, and insulin resistance syndrome. Studies in transgenic mice have demonstrated that calcium influences adipocyte metabolism. High calcium intake depresses levels of parathyroid hormone and 1,25-hydroxy vitamin D. These decreased hormone levels cause decreases in intracellular calcium, thereby inhibiting lipogenesis and stimulating lipolysis. High dietary calcium intakes also increases excretion of fecal fat and may increase core body temperature. Calcium from dairy products seems to have more of an impact than calcium from dietary supplements. Primary care providers should include recommendations about adequate calcium intake in standard dietary counseling about weight management.