Stool Fat Test
Stool fats, also known as fecal fats, or fecal lipids, are fats that are excreted in the feces. When secretions from the pancreas and liver are adequate, emulsified dietary fats are almost completely absorbed in the small intestine. When a malabsorption disorder or other cause disrupts this process, excretion of fat in the stool increases.
This test evaluates digestion of fats by determining excessive excretion of lipids in patients exhibiting signs of malabsorption, such as weight loss, abdominal distention, and scaly skin.
Drugs that may increase fecal fat levels include enemas and laxatives, especially mineral oil. Drugs that may decrease fecal fat include Metamucil and barium. Other substances that can affect test results include alcohol, potassium chloride, calcium carbonate, neomycin, kanamycin, and other broad-spectrum antibiotics.
Excessive excretion of fecal fat is called steatorrhea, a condition that is suspected when the patient has large, "greasy," and foul-smelling stools. Both digestive and absorptive disorders can cause steatorrhea. Digestive disorders affect the production and release of the enzyme lipase from the pancreas, or bile from the liver, which are substances that aid digestion of fats; absorptive disorders disturb the absorptive and enzyme functions of the intestine. Any condition that causes malabsorption or maldigestion is also associated with increased fecal fat. As an example, children with cystic fibrosis have mucous plugs that block the pancreatic ducts. The absence or significant decrease of the pancreatic enzymes, amylase, lipase, trypsin, and chymotrypsin, limits fat protein and carbohydrate digestion, resulting in steatorrhea due to fat malabsorption.
Both qualitative and quantitative tests are used to identify excessive fecal fat. The qualitative test involves staining a specimen of stool with a special dye, then examining it microscopically for evidence of malabsorption, such as undigested muscle fiber and various fats. The quantitative test involves drying and weighing a 72-hour stool specimen, then using an extraction technique to separate the fats, which are subsequently evaporated and weighed. This measurement of the total output of fecal fat per 24 hours in a three-day specimen is the most reliable test for steatorrhea.
This test requires a 72-hour stool collection. The patient should abstain from alcohol during this time and maintain a high-fat diet (100 g/day) for three days before the test, and during the collection period. The patient should call the laboratory for instructions on how to collect the specimen.
Reference values vary from laboratory to laboratory, but are generally found within the range of 5–7 g/24 hr.
It should be noted that children, especially infants, cannot ingest the 100 g/day of fat that is suggested for the test. Therefore, a fat retention coefficient is determined by measuring the difference between ingested fat and fecal fat, and expressing that difference as a percentage. The figure, called the fat retention coefficient, is 95% or greater in healthy children and adults. A low value is indicative of steatorrhea.
Increased fecal fat levels are found in cystic fibrosis, malabsorption secondary to other conditions like Whipple's disease or Crohn's disease, maldigestion secondary
Cahill, Mathew. Handbook of Diagnostic Tests. Springhouse, PA: Springhouse Corporation, 1995.
Pagana, Kathleen Deska. Mosby's Manual of Diagnostic and Laboratory Tests. St. Louis: Mosby, Inc., 1998.
Janis O. Flores