Objective: Intestinal malabsorption is a serious condition which unfortunately may remain unrecognized due to methodological problems. The old titration method of van de Kamer is still the gold standard. We present a modification of the method, pointing out practical improvements and pitfalls.
Material and methods: Our method uses less than one tenth of the amount of feces originally described, which implies proper mixing and homogenization of all feces collected over 72 hrs. Validation is performed by measuring fat concentration in commercial milk products.
Results: Reproducibility and validity were satisfactory. Concentration and output of fecal fat was poorly correlated, indicating that fecal output is required for diagnosing intestinal malabsorption. Our experiments also highlight the importance of using a non-polar extraction agent because polar agents take up water-soluble short chain fatty acids which are derived from fermentation of carbohydrates and give erroneous results.
Conclusion: The modified method is reliable and robust and minimizes the aesthetical problems associated with fecal fat determination.