Acid steatocrit in the first 2 years of life: diagnostic accuracy and reference limits

Mirosława Wieczorek-Filipiak; Sławomira Drzymała-Czyż; Dariusz Walkowiak; Jarosław Szydłowski; Anna Miśkiewicz-Chotnicka; Zuzanna Szajstek; Jerzy Moczko; Jarosław Walkowiak

doi:10.20883/jms.320

Authors

Mirosława Wieczorek-Filipiak Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Poznan, Poland https://orcid.org/0000-0002-8828-1550
Sławomira Drzymała-Czyż Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Poznan, Poland https://orcid.org/0000-0001-8291-5439
Dariusz Walkowiak Department of Organization and Management in Health Care, Poznan University of Medical Sciences, Poznań, Poland https://orcid.org/0000-0001-8874-2401
Jarosław Szydłowski Department of Paediatric Otolaryngology, Poznan University of Medical Sciences, Poznań, Poland https://orcid.org/0000-0002-8447-788X
Anna Miśkiewicz-Chotnicka Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Poznan, Poland https://orcid.org/0000-0001-5073-2435
Zuzanna Szajstek Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Poznan, Poland https://orcid.org/0000-0002-0585-7770
Jerzy Moczko Department of Computer Science and Statistics, Poznań University of Medical Sciences, Poznań, Poland https://orcid.org/0000-0002-4164-6196
Jarosław Walkowiak Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Poznan, Poland https://orcid.org/0000-0001-5813-5707

DOI:

https://doi.org/10.20883/jms.320

Keywords:

exocrine pancreatic function, healthy children, reference intervals, fecal free fatty acids

Abstract

Introduction. The measurement of acid steatocrit (AS) is an established method to assess faecal fat balance. However, data regarding AS in healthy infants and toddlers are sparse.
Aim. This study aimed to determine the range of normal values for AS in the first two years of life and evaluate the correlations with other faecal fat balance tests.
Material and Methods. AS (%) was assessed by 72-hour stool collection in 160 children aged 1–24 months (8 groups of 20: aged 1–3, 4–6 months, etc.).
Results. AS was higher in infants < 6 months than in those aged 7–12, 13–18 and 19–24 months (p < 0.05, p < 0.001 and p < 0.001, respectively). The correlations between AS and age and faecal fat concentration (FFC) were statistically significant, but moderate or weak (r = -0.48, p < 0.0001; r = 0.28, p < 0.001, respectively). A 90th/95th percentile nomogram of AS was created based on these results, with values ranging from 23.6/23.9% at 1 month to 12.1/12.9% at 24 months.
Conclusions. Healthy infants have a significantly higher AS than older children. For this reason, we propose an upper limits nomogram, providing detailed reference values for infants and children in their first two years of life. However, it should be noted that AS does not reflect adequately FFE and FFC in this population.

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References

Van De Kamer JH, Ten Bokkel Huinink H, Weyers HA. Rapid method for the determination of fat in feces. J Biol Chem. 1949 Jan;177(1):347–355.

Walkowiak J, Lisowska A, Blask‑Osipa A, Drzymała‑Czyz S, Sobkowiak P, Cichy W, et al. Acid steatocrit determination is not helpful in cystic fibrosis patients without or with mild steatorrhea. Pediatr Pulmonol. 2010 Mar;45(3):249–254.

Walkowiak J, Nousia‑Arvanitakis S, Henker J, Stern M, Sinaasappel M, Dodge JA. Indirect pancreatic function tests in children. J Pediatr Gastroenterol Nutr. 2005 Feb;40(2):107–114.

Girish BN, Rajesh G, Vaidyanathan K, Balakrishnan V. Fecal elastase1 and acid steatocrit estimation in chronic pancreatitis. Indian J Gastroenterol. 2009 Dec;28:(6)201–205.

Cohen JR, Schall JI, Ittenbach RF, Zemel BS, Stallings VA. Fecal elastase: pancreatic status verification and influence on nutritional status in children with cystic fibrosis. J Pediatr Gastroenterol Nutr. 2005 Apr;40(4):438–444.

Weintraub A, Blau H, Mussaffi H, Picard E, Bentur L, Kerem E, et al. Exocrine pancreatic function testing in patients with cystic fibrosis and pancreatic sufficiency: a correlation study. J Pediatr Gastroenterol Nutr. 2009 Mar;48(3):306–310.

Tran M, Forget P, Van den Neucker A, Strik J, van Kreel B, Kuijten R. The acid steatocrit: a much improved method. J Pediatr Gastroenterol Nutr. 1994 Oct;19(3):299–303.

Kamath MG, Pai CG, Kamath A, Kurien A. Comparing acid steatocrit and faecal elastase estimations for use in M‑ANNHEIM staging for pancreatitis. World J Gastroenterol. 2017 Mar;23(12):2217–2222.

Amann ST, Josephson SA, Toskes PP. Acid steatocrit: a simple, rapid gravimetric method to determine steatorrhea. Am J Gastroenterol. 1997 Dec;92(120:2280–2284.

Sperti C, Moletta L. Staging chronic pancreatitis with exocrine function tests: Are we better? World J Gastroenterol. 2017 Oct;23(38):6927–6930.

Van den Neucker AM, Kerkvliet EM, Theunissen PM, Forget PP. Acid steatocrit: a reliable screening tool for steatorrhoea. Acta Paediatr. 2001 Aug;90(8):873–875.

Catapani WR, da Silva AN, de Morais MB, Fagundes Neto U. Clinical usefulness of acid steatocrit in pediatric practice. Arq Gastroenterol. 1999 Apr‑Jun;36(2):105–108.

Lebenthal E, Lee PC. Development of functional responses in human exocrine pancreas. Pediatrics. 1980 Oct;66(40):556–560.

McClean P, Weaver LT. Ontogeny of human pancreatic exocrine function. Arch Dis Child. 1993 Jan;68(1):62–65.

Wieczorek‑Filipiak M, Drzymała‑Czyż S, Szczepanik M, Miśkiewicz‑Chotnicka A, Wenska‑Chyży E, Moczko JA, et al. Fecal elastase-1 in healthy children up to 2 years of age: a cross‑sectional study. Dev Period Med. 2018;22(2):123–127.

Cohen JF, Korevaar DA, Altman DG, Bruns DE, Gatsonis CA, Hooft L, et al. STARD 2015 guidelines for reporting diagnostic accuracy studies: explanation and elaboration. BMJ Open. 2016 Nov;6(11):e012799.

Van den Neucker AM, Forget P‑P, van Kreel B. Lipid, nitrogen, water and energy content of a single stool sample in healthy children and children with cystic fibrosis. Eur J Pediatr. 2003 Nov;162(11):764–766.

Wagner MH, Bowser EK, Sherman JM, Francisco MP, Theriaque D, Novak DA. Comparison of steatocrit and fat absorption in persons with cystic fibrosis. J Pediatr Gastroenterol Nutr. 2002 Aug;35(2):202–205.