Gastroenterology

Gastroenterology

Volume 116, Issue 2, February 1999, Pages 431-437
Gastroenterology

Liver, Pancreas, and Biliary Tract
Effect of bacterial or porcine lipase with low- or high-fat diets on nutrient absorption in pancreatic-insufficient dogs,☆☆

https://doi.org/10.1016/S0016-5085(99)70141-1Get rights and content

Abstract

Background & Aims: Treatment of human exocrine pancreatic insufficiency is suboptimal. This study assessed the effects of bacterial lipase, porcine lipase, and diets on carbohydrate, fat, and protein absorption in pancreatic-insufficient dogs. Methods: Dogs were given bacterial or porcine lipase and 3 diets: a 48% carbohydrate, 27% fat, and 25% protein standard diet; a high-carbohydrate, low-fat, and low-protein diet; or a low-carbohydrate, high-fat, and high-protein diet (66%/18%/16% and 21%/43%/36% calories). Results: With the standard diet, coefficient of fat absorption increased dose-dependently with both lipases (P < 0.05), but more fat was absorbed with porcine lipase (P < 0.05); 600,000 IU of bacterial lipase (240 mg) and 300,000 IU of porcine lipase (18 g) nearly abolished steatorrhea. With 300,000 IU of bacterial lipase or 135,000 IU of porcine lipase, fat absorption was greater with the high-fat and -protein diet (P < 0.05 vs. low-fat and -protein diet). There were no interactions among carbohydrate, fat, and protein absorption. Conclusions: Correcting steatorrhea requires 75 times more porcine than bacterial lipase (18 vs. 240 mg). High-fat and high-protein diets optimize fat absorption with both enzymes. High-fat diets with bacterial or porcine lipase should be evaluated in humans with pancreatic steatorrhea.

GASTROENTEROLOGY 1999;116:431-437

Section snippets

Preparation of pancreatic-insufficient dogs and their maintenance

All procedures and experiments were reviewed and approved by the Institutional Animal Care and Use Committee of the Mayo Foundation in accordance with the guidelines of the National Institutes of Health and the Public Health Policy on the Humane Use and Care of Laboratory Animals.

Five female dogs weighing between 18 and 21 kg were used. Dogs were anesthetized with an intravenous injection of thiopental sodium and then underwent endotracheal intubation. Anesthesia was maintained by halothane

Effects of exocrine pancreatic insufficiency on body weight, food intake, and blood glucose

Dogs with exocrine pancreatic insufficiency lost 7% ± 2% (2%–13%) of their body weight, but they continued to rapidly ingest entire meals. There were no significant changes in postprandial blood glucose levels during the studies (data not shown).

Dose response and comparison of the effects on steatorrhea between BL and PL with maintenance diet (27% fat)

After operation, untreated pancreatic-insufficient dogs absorbed less fat (CFA, 63% ± 6% vs. 96% ± 1%; P < 0.01; Figure 1).

. Dose response and correction of steatorrhea in 5 pancreatic-insufficient dogs fed a standard meal of 580 kcal (47% carbohydrate,

Discussion

Human pancreatic steatorrhea is rarely eliminated by current therapy. In the present and a previous study,1 we report that combining 300,000 IU of BL with a high proportion of fat in the diet corrects steatorrhea in canine exocrine insufficiency. These data engender hope that BL and diet therapy may improve treatment of pancreatic steatorrhea. Now we also show that a high-fat and high-protein diet improves CFA in response to PL. Thus, we suggest that in humans with pancreatic steatorrhea,

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    Address requests for reprints to: Eugene P. DiMagno, M.D., Gastroenterology Research Unit (Alfred 2-435), Mayo Clinic, 200 First Street Southwest, Rochester, Minnesota 55905. Fax: (507) 255-6318.

    ☆☆

    Supported in part by a grant from Knoll AG, Ludwigshafen, Germany, and the Mayo Foundation.

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