title: Serum 7-alpha-hydroxy-4-cholesten-3-one as a marker for bile acid loss in children.
abstract: OBJECTIVE
  To establish age-related reference values for 7-alpha-hydroxy-4-cholesten-3-one (C4) in a pediatric population and to investigate bile acid malabsorption in children with short bowel syndrome (SBS).
  
  
  METHODS
  Serum was obtained between 8:00 a.m. and 11:00 a.m. from 100 healthy children (52% males, 9 months to 18 years of age) after 10 hours of fasting. Pediatric patients with SBS served as disease controls (n = 12). Following solid-phase extraction and purification, C4 was determined by high-performance liquid chromatography using a ultraviolet detector at a wavelength of 241 nm. The upper limit of normal for C4 concentrations was defined as the mean plus 2 SD of the log-normal distribution.
  
  
  RESULTS
  The mean concentration and SD of C4 in healthy children was 22.8 ± 15.8 ng/mL with no relation to age or sex and an upper limit of normal of 66.5 ng/mL. Normal C4 values were found in 97 of 100 healthy children, and all 12 patients with SBS had C4 concentrations above 100 ng/mL (mean 299.6 ± 167.8 ng/mL; range 105.7-562.1 ng/mL, P < .0001 compared with controls).
  
  
  CONCLUSIONS
  The determined upper limit of normal for C4 concentration in healthy children corresponds to previously published levels in healthy adults and is independent of age and sex. The consistently elevated C4 concentrations in our patients with SBS confirm the reliability of this noninvasive, nonisotopic method to assess bile acid malabsorption in children.
authors: Department of Pediatric Gastroenterology and Hepatology, Dr von Hauner Children's Hospital, Ludwig-Maximilians University, Munich, Germany. Electronic address: folke.freudenberg@med.uni-muenchen.de.
authors: Folke
authors: F
authors: Freudenberg
authors: Florian
authors: F
authors: Gothe
authors: Florian
authors: F
authors: Beigel
authors: Christian
authors: C
authors: Rust
authors: Sibylle
authors: S
authors: Koletzko
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001647:Bile Acids and Salts / Q000378:metabolism*; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D002783:Cholestenones / Q000097:blood*; D002851:Chromatography, High Pressure Liquid; D005260:Female; D006801:Humans; D007223:Infant; D008286:Malabsorption Syndromes / Q000097:blood*; D008297:Male; D012016:Reference Values; D012778:Short Bowel Syndrome / Q000097:blood*
chemical_list: D001647:Bile Acids and Salts; D015415:Biomarkers; D002783:Cholestenones; C002656:7 alpha-hydroxy-4-cholesten-3-one
keywords: 7-alpha-hydroxy-4-cholesten-3-one; BAM; Bile acid malabsorption; C4; HPLC; High-performance liquid chromatography; ICV; Ileocecal valve; PN; Parenteral nutrition; SBS; Short bowel syndrome