Luminal events of lipid absorption in protein-calorie malnourished children; relationship with nutritional recovery and diarrhea. II. Alterations in bile acid content of duodenal aspirates

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Abstract
Duodenal aspirates from PCM patients and from children with diarrhea present quantitative and qualitative alterations in their content of bile acids, consisting mainly in decreased concentrations of conjugated bile acids (CBA) and increased amounts of primary and secondary free bile acids (FBA). In the absence of diarrhea, PCM was associated with relatively uniform decrements of CBA, increasing to normal levels with nutritional recovery; the amounts of primary and secondary FBA did not change significantly with recovery. The effect of diarrhea on the bile composition of the children varied depending on the patient’s nutritional status: a) In recovered children with diarrhea, all CBA, especially the taurine conjugates, were decreased; the glycine/taurine (G/T) ratios were above 1:4 in most of these patients. Although all FBA increased with diarrhea, such an increase was most significant in cholic and lithocholic acids; these children also presented high FBA/CBA ratios. b) In PCM children, the degree of decrement of CBA during diarrhea was similar in taurine and glycine conjugates, the G/T ratio remaining within normal limits. The concentrations of primary and secondary FBA did not change significantly in PCM children with diarrhea when compared with the group without diarrhea. It is believed that the changes in bile acids observed in these children are due to the interaction of malnutrition, diarrhea, and an increased gastrointestinal flora. A theory of how the bile acid events described herein occur is also proposed.