Low Serum Cholesterol Levels and Subclinical Malabsorption

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Abstract
Ambulatory and outwardly healthy Puerto Ricans with serum choles-terols of 160 mg/100 ml or less, who were selected only on the basis of cholesterol level, were tested with d-xylose for the presence of clinically occult malabsorption. From this same population, individuals with cholesterols which were at least 100 mg/100 ml higher were chosen in a similar manner for comparative study. Urine xylose excretion was found impaired (< 4.0 gm/5 hr.) in over 55% of the low cholesterol group (54 individuals) and in only 15% (40 individuals) of those with elevated values. In the absence of any demonstrated significant dietary differences in the 2 cholesterol groups, it is suggested that malabsorption is the mechanism responsible for the low serum cholesterols which are found in a large segment of this community. Extended laboratory investigation in subjects with xylose excretions of less than 4.0 gm, who as a group were clinically indistinguishable from the non-affected, was chiefly notable for: absent to minimal jejunal histologic abnormalities in 2/3; mucosal disaccharidase deficiencies in the overwhelming majority, and, when present, steatorrhea of usually minimal proportions. It is concluded that the described disorder of absorption appears to be an early variant of tropical sprue which is widespread, and which, though largely unimpressive by clinical and morphologic criteria, may be productive of significant functional abnormalities.

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