Steatorrhea in young children: what to do?

Abstract

Making sure that the child is absorbing properly the main nutrients such as proteins, fats, carbohydrates, and vitamins, macro- and micronutrients is a key influencer when it comes to the harmonious growth and development. In infants, triglycerides digestion starts in the stomach, where three lipases – human milk, gastric and lingual lipases – split triglycerides. The participation of breast milk lipase stimulated by bile salts in the duodenum in splitting fats is an important feature of digestion in breastfed babies. The absorption of fatty acids differs depending on the length of the carbon chain and the location of the fatty acid in the glycerol molecule. Short-chain and medium-chain fatty acids, as well as glycerine, choline are hydrophilic compounds, which are absorbed without pancreatic lipase and bile acids, directly into the blood, bypassing the lymphatic system. The specific configuration of human milk triglycerides improves the absorption of fatty acids. In situations where lipids digestion or absorption appears impaired, one may talk of steatorrhea. If young children have type I steatorrhea (the presence of neutral fat in stool), it is first required to exclude absolute exocrine pancreatic insufficiency: cystic fibrosis, Shwachman-Diamond syndrome, Pearson syndrome, isolated lipase deficiency (Sheldon – Ray syndrome), etc. Type II steatorrhea (excretion of fatty acids in stool) is not a specific symptom of certain diseases, but is often observed in the small intestine pathology.