Fat Malabsorption

Fat Malabsorption refers to the impairment of fat digestion which mainly occurs in the small intestine. Malabsorption means the body is not properly absorbing nutrients from foods. It leads to malnutrition because the body does not receive the nutrients (vitamins, minerals, proteins, sugars, fats, etc) that it requires.

Most of these nutrients are absorbed through the small intestine.

Malnutrition can result when:

• A person does not enough food or calories.
• When a person eats enough food but cannot absorb the nutrients.
• When a person eats enough food or calories, but foods that contain little nutrients (such as candy).

Proper function of the pancreas, bile ducts, liver and the lining cells of the small intestines are necessary for the foods eaten to be broken down into the constituents that can be absorbed from the intestine into the blood stream.

Types

Probably the most frequent form of malabsorption is of sugars (usually lactose or milk sugar). This type of malabsorption may cause symptoms of gas, bloating, abdominal pain and diarrhea.

Fat malabsorption is more serious. Indications of fat malabsorption condition include large volume stool and weight loss. Fat globules in the stool may be evident with microscopic examination. Fat malabsorption requires evaluation of the pancreas, bile ducts and small intestine.

Some people may suffer with iron deficiency anemia as a result of iron malabsorption by the small intestine. Frequently this is caused by celiac disease.

Causes

• Acutely abnormal intestinal lining due to an acute intestinal infection, use of antibiotics, particularly Neomycin, and alcohol.

• Chronically abnormal intestinal lining present in Crohn's Disease and Celiac Disease.

• Improper intestinal environment due to bacterial overgrowth or parasites in the digestive tract.

• Inadequate gastric mixing as a result of fistula in the gastric environment, and gastroenterostomy.

• Short bowel as a result of intestinal resection.
• Impaired transport of enzymes.

Signs and Symptoms

Symptoms of malabsorption may include one or more of the following:

• Diarrhea
• Weight loss
• Skin changes
• Dehydration
• Fatigue
• Abdominal pain
• Bloating
• Anemia
• Foul smelling stools
• Oily stools
• Undigested food in stools

Diagnosis

Exams and Tests

Great Smokies comprehensive home stool test can give more insight into the digestive function and gut microbial ecology. The test offers a non-invasive differential diagnosis between Inflammatory Bowel Disease (Crohn's Disease and Ulcerative Colitis) and Irritable Bowel Syndrome (IBS), expanded bacteria, yeast and parasite detection, a reliable assessment of exocrine pancreatic function, and a noninvasive risk assessment for colorectal cancer.

Other tests can be perfomed in order to rule out other causes for malabsorption. The are common and relatively inexpensive. These tests include:

• Complete Blood Count (CBC):This test can determine if anemia is the reason for the malabsortion.
• Serum electrolytes: Malabsorption can be caused by electrolyte imbalances, such as low levels of calcium, potassium, or magnesium.
• CT scan (CAT scan): This imaging test can determine if there is an underlying disease such as chronic pancreatitis, enlarged lymph nodes that can point to lymphoma or Whipple disease.

Treatment

Treating fat malabsorption means treating the underlying cause of the disease. It often means looking at the diet to make sure that enough supplements are given to ensure good health. It is important to make sure that enough proteins and calories are being eaten. Various supplements such as vitamins and minerals should be taken to make up for those that are missing. Discuss diet with a doctor or a dietician. A doctor can also review any medications to see if any of them are causing or worsening the fat malabsorption.

Clinical Trials

• Malabsorption Blood Test:Toward a Novel Approach to Quantify Steatorrhea (MBT)

Other Resources

• The Merck Manual of Geriatrics

References

• Bai JC. Malabsorption syndromes. Digestion. Aug 1998;59(5):530-46.
• Lindley KJ, Macdonald S. Malabsorption in children. Practitioner. Mar 2001;245(1620):162-4, 166, 169-70 passim.
• Holt PR. Diarrhea and malabsorption in the elderly. Gastroenterol Clin North Am. Jun 2001;30(2):427-44.