Cholesterol metabolism in pediatric short bowel syndrome after weaning off parenteral nutrition

Abstract Background Small intestine essentially regulates cholesterol homeostasis. Aims To evaluate cholesterol metabolism in short bowel syndrome (SBS). Methods Cholesterol precursors (e.g., cholestenol, desmosterol and lathosterol) and plant sterols (campesterol and sitosterol), respective markers...

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Bibliographic Details
Published in:Digestive and liver disease 2010-08, Vol.42 (8), p.554-559
Main Authors: Pakarinen, Mikko P, Kurvinen, Annika, Gylling, Helena, Miettinen, Tatu A, Pesonen, Maria, Kallio, Markku, Koivusalo, Antti I, Nissinen, Markku J
Format: Article
Language:English
Subjects:
Bile Acids and Salts - metabolism
Child
Child, Preschool
Cholesterol - biosynthesis
Cholesterol - blood
Cholesterol precursors
Cholesterol synthesis
Desmosterol - blood
Gastroenterology and Hepatology
Humans
Intestinal Absorption
Intestinal adaptation
Intestinal failure
Intestine, Small - metabolism
Intestine, Small - pathology
Intestine, Small - physiopathology
Malabsorption Syndromes - metabolism
Malabsorption Syndromes - physiopathology
Malabsorption Syndromes - therapy
Parenteral Nutrition
Phytosterols - blood
Plant sterols
Short bowel syndrome
Short Bowel Syndrome - metabolism
Short Bowel Syndrome - pathology
Short Bowel Syndrome - physiopathology
Short Bowel Syndrome - therapy
Sterols - blood
Time Factors
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Summary:Abstract Background Small intestine essentially regulates cholesterol homeostasis. Aims To evaluate cholesterol metabolism in short bowel syndrome (SBS). Methods Cholesterol precursors (e.g., cholestenol, desmosterol and lathosterol) and plant sterols (campesterol and sitosterol), respective markers of cholesterol synthesis and absorption, were determined in SBS patients ( n = 12) an average of 31 months after weaning off parenteral nutrition and in age-matched controls ( n = 80). Results Among patients, serum cholesterol precursor sterol to cholesterol ratios were 2–10 times higher ( P < 0.0001 for each). Those without any remaining ileum had 1.2–2.8 times higher precursor sterol to cholesterol ratios than those with an ileal remnant ( P < 0.05 for each). Serum cholesterol concentration, campesterol/cholesterol and campesterol/sitosterol were 34–39% lower ( P < 0.05 for each) in relation to controls. Bile acid absorption was markedly impaired (2.4 (0.2–3.2)%). Plant sterol ratios reflected the absolute length of remaining jejunum ( r = 0.625–0.663), and precursor sterol ratios inversely that of ileum ( r = −0.589 to 0.750, P < 0.05 for all). Conclusion After weaning off parenteral nutrition, patients with pediatric onset SBS continue to have marked intestinal malabsorption of bile acids and moderate cholesterol malabsorption resulting in decreased serum cholesterol despite a marked compensatory increase in cholesterol synthesis.
ISSN:1590-8658
1878-3562
DOI:10.1016/j.dld.2010.01.003