Diagnosis of lipid malabsorption in patients with chronic pancreatitis: a new indirect test using postprandial plasma apolipoprotein B-48.
OBJECTIVE
This study was done to evaluate a new test for fat malabsorption caused by chronic pancreatitis. Postprandial plasma apolipoprotein B-48 was measured as an indicator of the intestinal assimilation of exogenous lipid.


METHODS
Twenty-three patients with chronic pancreatitis, including 19 insulin-treated diabetic patients, were compared with 14 healthy subjects and seven type-1 diabetic patients. Each was given a test meal containing 40 g lipid; the triglyceride apolipoprotein B-48 concentrations in chylomicrons were determined 240 min later.


RESULTS
The postprandial chylomicron apolipoprotein B-48 concentrations in the three groups were statistically different at 240 min: pancreatitis versus controls, p < 0.01, and pancreatitis versus type-1 diabetes subjects, p < 0.01. The delta plasma apo B-48, the change in apolipoprotein B-48 between 0 and 240 min, was significantly smaller in chronic pancreatitis patients than in controls (p < 0.001) and type-1 diabetes subjects (p < 0.001). The sensitivity of the test was better than 89% for a delta apo B-48 threshold value of 0.42 mg/dl.


CONCLUSIONS
This new indirect test is relatively simple to use and could be practical for evaluating exogenous lipid malabsorption due to chronic pancreatitis.
Saviana
B
B
Fédération des Maladies de l'Appareil Digestif et EP CNRS 616, CHU Nancy-Brabois, Vandoeuvre, France.
Quilliot
D
D
Ziegler
O
O
Bigard
M A
MA
Drouin
P
P
Guéant
J L
JL
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D053283:Apolipoprotein B-48; D001055:Apolipoproteins B / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D002446:Celiac Disease / Q000209:etiology; D002784:Cholesterol / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D002908:Chronic Disease; D002914:Chylomicrons / Q000097:blood; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D004435:Eating; D010188:Exocrine Pancreatic Insufficiency / Q000175:diagnosis / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D007408:Intestinal Absorption; D050356:Lipid Metabolism; D008286:Malabsorption Syndromes / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000150:complications*; D012680:Sensitivity and Specificity; D014280:Triglycerides / Q000097:blood
D053283:Apolipoprotein B-48; D001055:Apolipoproteins B; D015415:Biomarkers; D008078:Cholesterol, LDL; D002914:Chylomicrons; D014280:Triglycerides; D002784:Cholesterol