title: A novel method to identify fat malabsorption: the Serum Retinyl Palmitate Test.
abstract: BACKGROUND
  Malabsorptive etiologies of chronic diarrhea are important to identify. The 72-h stool for fecal fat test (FFT), the gold standard for diagnosing fat malabsorption, is fraught with limitations that impact its reliability. Vitamin A, a fat-soluble vitamin, parallels the absorption of lipids. We assessed the feasibility and validate a novel clinical test, retinyl palmitate (RP), for the diagnosis of fat malabsorption, and to compare the results to the FFT.
  
  
  METHODS
  Using a case-control study design, patients with chronic diarrhea secondary to suspected malabsorption, and healthy control subjects were identified. A Dietitian taught subjects to consume a 100g fat diet for the FFT with measurements of stool fat after 72-h. Serum levels of Vitamin A (retinol) and RP were measured by reversed-phase high pressure liquid chomatography. Two-way comparisons were made between the groups using 2 sample Wilcoxon rank-sum tests.
  
  
  RESULTS
  Sixteen patients completed this study (8 cases and 8 control subjects). Fecal fat results were available for 15/16 patients. The sensitivity of the FFT was 100% (identified all cases), but the FFT specificity was 42%, as 4/7 control patients were identified as malabsorbers. Cases with short bowel syndrome had the lowest RP levels but this did not meet statistical significance. There was no significant difference for serum RP levels when comparing cases and control patients' AUC.
  
  
  CONCLUSIONS
  Serum RP is useful to identify malabsorption, albeit in severe cases. Furthermore, we have shown that the 72-hour FFT has poor performance characteristics, highlighting the need for more useful diagnostics in identifying malabsorption.
authors.affiliation: University of Calgary, 69 Cresthaven Rise SW, Calgary, AB T3B5X9, Canada. Electronic address: mkothand@ucalgary.ca.
authors.forename: Maitreyi
authors.initials: M
authors.lastname: Raman
authors.affiliation: University of Calgary, 69 Cresthaven Rise SW, Calgary, AB T3B5X9, Canada.
authors.forename: Tanis
authors.initials: T
authors.lastname: Fenton
authors.affiliation: University of Calgary, 69 Cresthaven Rise SW, Calgary, AB T3B5X9, Canada.
authors.forename: Pam
authors.initials: P
authors.lastname: Crotty
authors.affiliation: University of Calgary, 69 Cresthaven Rise SW, Calgary, AB T3B5X9, Canada.
authors.forename: Subrata
authors.initials: S
authors.lastname: Ghosh
authors.affiliation: University of Calgary, 69 Cresthaven Rise SW, Calgary, AB T3B5X9, Canada.
authors.forename: Kevin
authors.initials: K
authors.lastname: Rioux
authors.affiliation: University of Calgary, 69 Cresthaven Rise SW, Calgary, AB T3B5X9, Canada.
authors.forename: Rajveer
authors.initials: R
authors.lastname: Hundal
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002851:Chromatography, High Pressure Liquid; D003967:Diarrhea / Q000378:metabolism*; D004041:Dietary Fats / Q000378:metabolism*; D004224:Diterpenes; D005260:Female; D006801:Humans; D008286:Malabsorption Syndromes / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D000084562:Retinyl Esters; D014801:Vitamin A / Q000031:analogs & derivatives* / Q000378:metabolism
chemical_list: D004041:Dietary Fats; D004224:Diterpenes; D000084562:Retinyl Esters; D014801:Vitamin A; C014794:retinol palmitate
keywords: Chronic diarrhea; Fecal fat test; Malabsorption; Retinyl palmitate