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

Dig Liver Dis. 2010 Aug;42(8):554-9. doi: 10.1016/j.dld.2010.01.003. Epub 2010 Jun 9.

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bile Acids and Salts / metabolism
  • Child
  • Child, Preschool
  • Cholesterol / biosynthesis
  • Cholesterol / blood*
  • Desmosterol / blood
  • Humans
  • Intestinal Absorption
  • Intestine, Small / metabolism
  • Intestine, Small / pathology
  • Intestine, Small / physiopathology
  • Malabsorption Syndromes / metabolism
  • Malabsorption Syndromes / physiopathology
  • Malabsorption Syndromes / therapy
  • Parenteral Nutrition
  • Phytosterols / blood
  • Short Bowel Syndrome / metabolism*
  • Short Bowel Syndrome / pathology
  • Short Bowel Syndrome / physiopathology
  • Short Bowel Syndrome / therapy
  • Sterols / blood
  • Time Factors

Substances

  • Bile Acids and Salts
  • Phytosterols
  • Sterols
  • Desmosterol
  • lathosterol
  • Cholesterol