Bile acids, in a random sample of urine, discriminated normal controls from liver disease, with a probability similar to fasting plasma bile acids (p less than 0.01 and p less than 0.001, depending on the analytical technique). A high degree of correlation between urinary and plasma bile acids (up to r = 0.93) was achieved only when the urine flow was corrected by using a urinary bile acids/creatinine ratio but not with urinary bile acids as simple volume concentration. These findings originated from 10 patients with severe liver disease and 10 with mild liver disease, all biopsy-confirmed, compared with controls. In 24 normal controls and 24 histologically confirmed compensated liver disease, the predictive value of urinary bile acids/creatinine equaled or exceeded fasting plasma bile acids and routine liver tests. In a patient recovering from subacute hepatic necrosis, the urinary bile acids/creatinine closely resembled changes in plasma bile acids and in the routine liver tests. When sulfated urinary bile acids were included, the discrimination between liver disease and controls did not improve. Gallbladder contraction induced by parenteral analogs of cholecystokinin did not change urinary bile acids/creatinine, despite a significant increase in the plasma bile acids. Collection of fasting urine is thus not necessary. Urinary bile acids/creatinine in 12 subjects with renal insufficiency and moderate impairment of creatinine clearance was not different from controls. The weight/height index did not affect this urinary test: there was no significant correlation between the two. Available radioimmunoassays for plasma bile acids can be easily adapted for urine.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMedDate not supplied

Ultraviolet light irradiation and fat metabolism in guinea pigs subjected to exogenous cholesterol feeding.

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Adipose Tissue↗

PubMedDate not supplied

How much dietary fat in therapeutic nutrition?

Dietary fat has a less prominent role in realimentation than the alternate source of energy, carbohydrate. Presently available therapeutic diets, in typical feeding routines, provide only 3 to 120 g of fat per day. Three major factors contribute to fat underutilization: long-standing belief that fat is to blame for various vague symptoms of indigestion, misconception that daily fecal fat in excess of 7 g represents bowel dysfunction, and fear of fat-induced atherogenesis. None of these apply to refeeding starved and malnourished patients. The small intestine has a vastly underutilized capacity for fat absorption, and at the habitual fat intake of 100 g per day absorption is complete in the proximal one fifth of the gut. In patients requiring vigorous realimentation, the remaining small intestine should also be utilized. Dietary fat is well tolerated, and daily intakes of 500 g of polyunsaturated fat in a complete diet have not been associated with important side effects, while there was a significant improvement in body stores of fat and protein. Compared to diets high in carbohydrate, adequate intake of fat results in better nutrient utilization, less CO2 production and decreased lipogenesis and insulin requirements. Diets higher in fat are also better tolerated because of their lower volume and osmolality. The result is more effective absorption of calories and a faster nutritional recovery. Increased adipose tissue and protein reserve benefits patients who are in stress, immunocompromised, or debilitated. Adequate dietary fat should be considered for malnourished subjects with intact gastrointestinal function, and when intestinal absorptive capacity is reduced by surgery or disease.

Dietary Fats↗

PubMedDate not supplied

Urinary bile acids in population screening for inapparent liver disease.

BACKGROUND/AIMS: We performed this study in order to evaluate the diagnostic potential of bile acids in random samples of urine for detection of latent liver disease and to compare a radioimmunoassay for urine bile acids with an enzymatic method that detects bile acid sulfates. This was a prospective cohort study carried out at the VA Medical Center involving 151 adults who attended a Community Health Fair at the hospital and wanted to know if they had liver disease. METHODOLOGY: Urinary bile acids in random specimens of 5-10 ml urine were measured. Radioimmunoassay for primary bile acids and an enzymatic assay with or without sulfated bile acids, all corrected with creatinine for urine flow were performed. Serum primary bile acids were determined by radioimmunoassay. In addition, routine liver profile and clinical examination were carried out. RESULTS: In 78 of 151 subjects there was at least one recent liver profile to match with the urine bile acids. Of these 78, 52 subjects with normal urine bile acids had a normal liver profile. In 11 subjects abnormal urine bile acids were associated with an abnormal liver profile. Nine of these 11 subjects were anti HCV positive, one was HIV positive. Urine bile acids correctly predicted the outcome of routine liver tests in 89% of 78 subjects. In nine cases there was a discordance between urinary bile acids and the liver profile. Failure to correctly predict the liver profile using urine, was reduced from nine subjects to three when urine bile acids were obtained twice at separate intervals. Urine bile acids predicted the outcome of anti HCV testing in 37 subjects with similar accuracy as serum ALT or AST. Urine bile acids correlated with serum bile acids at r=0.96, 0.88 and 0.76 for the radioimmunoassay, enzymatic assay that included sulfated bile acids and enzymatic assay without the sulfates, respectively. CONCLUSION: Bile acids in a random sample of urine are useful for population screening for latent liver disease. Prediction of sub-clinical hepatitis C is comparable to that of serum ALT or AST. Inclusion of bile acid sulfates mildly increases the predictive value of urine. Urine bile acids highly correlate with serum bile acids, indicating their surrogate diagnostic value.

Bile Acids and Salts↗