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Energy malabsorption: measurement and nutritional consequences

S B Heymsfield, J Smith, S Kasriel

    The American Journal of Clinical Nutrition
    |September 1, 1981
    PubMed
    Summary

    Bomb calorimetry accurately measured fecal energy loss in patients with malabsorption. This method proved superior to standard tests for assessing energy balance and malnutrition.

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    Area of Science:

    • Gastroenterology
    • Nutritional Science
    • Clinical Chemistry

    Background:

    • Malabsorption syndromes significantly impact nutrient and energy utilization.
    • Accurate quantification of fecal energy (FE) loss is crucial for managing patients with suspected malabsorption.
    • Traditional clinical tests for malabsorption have limitations in assessing energy balance.

    Purpose of the Study:

    • To evaluate the utility of bomb calorimetry in measuring fecal energy loss.
    • To compare the accuracy of bomb calorimetry with standard clinical tests in patients with and without malabsorption.
    • To assess the impact of fecal energy loss on energy balance and nutritional status.

    Main Methods:

    • Fecal energy loss was determined using bomb calorimetry in 30 patients (14 with malabsorption history, 16 without).

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  • Digestibility, fecal energy loss, and metabolizable energy were calculated.
  • Standard malabsorption tests (fecal fat, nitrogen, stool weight) were compared to bomb calorimetry results.

    • Main Results:

    • Patients with malabsorption exhibited significantly higher fecal energy loss (493 kcal/day) and lower energy digestibility (73%) compared to controls (74 kcal/day, 96%).
    • Five of seven patients with malabsorption had inadequate metabolizable energy, leading to negative energy balance, weight loss, and protein-energy malnutrition.
    • Standard clinical tests were poor predictors of fecal energy loss and ineffective in assessing dietary modification effects.

    Conclusions:

    • Bomb calorimetry offers a simple, accurate method for quantifying fecal energy loss in malabsorption.
    • Standard clinical tests are insufficient for assessing energy malabsorption and its consequences.
    • Accurate measurement of fecal energy loss is essential for clinical management of malabsorption and preventing malnutrition.