Abstract
A patient with only 137 cm of jejunum suffereing from excessive jejunostomy losses was studied on three isocaloric liquid formula diets (3850 kcal/24 hr) differing only in carbohydrate and fat content. An increase in dietary fat from 64 g to 200 g per 24 hr and a reciprocal decrease in dietary carbohydrates resulted in a linear increase in the amount of fat absorbed, from 44 g to 133 g and in a 2.5-fold decrease in ostomy fluid bile acids. No undesirable side effects were noted on the 200-g fat diet: the ostomy fluid dry weight was lower than on 64 g of fat and the ostomy fluid output was lowest of all diets. Compared to healthy adults, the patient had higher fasting blood insulin and pancreatic glucagon. Meal-stimulated insulin, glucagon, gastrin, and GIP were also more than two standard errors above mean responses observed in healthy subjects. Smallest meal-stimulated increase in insulin, gastrin and GIP was noted on the 200-g fat diet. This diet induced the highest levels of glucagon. In a hormonally hyperactive individual after massive resection of the distal intestine favorable effects of a high-fat diet consist of increased absorption of dietary fat and bile acids and reduced release of gastroenteropancreatic hormones with the exception of glucagon.
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References
Simko V, Linscheer WG: Absorption of different elemental diets in a short-bowel syndrome lasting 15 years. Am J Dig Dis 21:419–425, 1976
Van deKamer JH, Huinink TB, Wegers HA: Rapid method for the determination of fat in feces. J Biol Chem 177:347–355, 1949
Talalay P: Enzymic analysis of steroid hormones.In Methods of Biochemical Analysis, D Glick (ed). New York, Interscience Publishers, 1960, pp 119–143
Morgan CR, Lazarow A: Immunoassay of insulin. Two antibody system. Plasma insulin levels in normal, subdiabetic and diabetic rats. Diabetes 12:115–126, 1963
Unger RH, Eisentraut AM, McCall MS, Madison LL: Glucagon antibodies and an immunoassay for glucagon. J Clin Invest 40:1280–1289, 1961
Buchanan KD, Teale JD, Harper G, Hayes JR, Trimble ER: Plasma secretin assay in man. Clin Sci Mol Med 45:13–14P, 1973
O'Dorisio TM, Cataland S, Stevenson MS, Mazzaferri, EL: Gastric inhibitory polypeptide (GIP): Intestinal distribution and stimulation by amino acids and medium chain triglycerides. Am J Dig Dis 21:761–765, 1976
Haymond HE: Massive resection of small intestine: Analysis of 257 collected cases. Surg Gynecol Obstet 61:693–705, 1935
West ES, Montague JR: Digestion and absorption in a man with three feet of small intestine. Am J Dig Dis 5:690–692, 1938
Althausen TL, Uyeyama K, Simpson RG: Digestion and absorption after massive resection of the small intestine. Utilization of food from a “natural” versus a “synthetic” diet and a comparison of intestinal absorption tests with nutritional balance studies in a patient with only 45 cm of small intestine. Gastroenterology 12:795–807, 1949
Pullan JM: Massive intestinal resection. Proc R Soc Med 52:31–37, 1959
Borgström B: Studies on intestinal cholesterol absorption in the human. J Clin Invest 39:809–815, 1960
Hofmann AF, Borgström B: The intraluminal phase of fat digestion in man: The lipid content of the micellar and oil phases of intestinal content obtained during fat digestion and absorption. J Clin Invest 43:247–257, 1964
Simmonds WJ: Uptake of fatty acids and monoglycerides.In Lipid Absorption, Biochemical and Clinical Aspects, K Rommel (ed). Baltimore, University Park Press, 1976, pp 51–61
Schwartz MK, Medwid A, Roberts KE, Sleisenger M, Randall HT: Fat and nitrogen metabolism in patients with massive small bowel resections. Surg Forum 6:385–390, 1955
Osborne MP, Frederick RL, Sizer JS, Blair D, Cole P, Thum W: Mechanism of gastric hypersecretion following massive intestinal resection. Clinical and experimental observations. Ann Surg 164:622–634, 1966
Barros D'Sa AAB, Buchanan KD: Role of gastrointestinal hormones in the response to massive resection of the small bowel. Gut 18:877–881, 1977
Necheles H, Sporn J, Walker L: Effect of glucagon on gastrointestinal motility. Am J Gastroenterol 45:34–39, 1966
Snape WJ, Matarazzo SA, Cohen S: Effect of eating and gastrointestinal hormones on human colonic myoelectrical and motor activity. Gastroenterology 75:373–378, 1978
Gross RA, Isenberg JI, Hogan D, Samloff IM: Effect of fat on meal stimulated duodenal acid load, duodenal pepsin load, and serum gastrin in duodenal ulcer and normal subjects. Gastroenterology 75:357–362, 1978
Konturek SJ, Grossman MI: Effects of perfusion of intestinal loops with acid, fat or dextrose on gastric secretion. Gastroenterology 49:481–489, 1965
Cataland S: Physiology of GIP in man.In Gut Hormones, SR Bloom (ed). Edinburgh, Churchill, Livingstone, 1978, pp 288–293
Debas HT, Yamagishi T: Gastric inhibitory polypeptide (GIP) is not the primary mediator of the enterogastrone action of fat. Gastroenterology 74:1118, 1978
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Simko, V., McCarroll, A.M., Goodman, S. et al. High-fat diet in a short bowel syndrome. Digest Dis Sci 25, 333–339 (1980). https://doi.org/10.1007/BF01308056
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DOI: https://doi.org/10.1007/BF01308056