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Relationships between serum lipids and malabsorption of bile acids, neutral sterols, and fats in exocrine pancreatic insufficiency.

The relationship between serum lipids, fecal steroids, and fecal fat was studied in nine men with exocrine pancreatic insufficiency due to chronic pancreatitis. The mean fecal bile acid and fat outputs were significantly increased, the neutral sterol excretion was within normal limits, and total elimination and synthesis of cholesterol were slightly increased. A positive correlation between fecal fat and neutral sterols suggests that the patients actually had cholesterol malabsorption and that the normal neutral sterol excretion was apparently the result of a low biliary cholesterol secretion. In view of the fairly small increase in cholesterol elimination, the serum cholesterol level was surprisingly low, indicating that malnutrition may have limited compensatory increase in cholesterol synthesis. Serum triglycerides were negatively correlated with fecal fat. Thus, severe malabsorption apparently also limited the triglyceride production.