Effect of bacterial or porcine lipase with low- or high-fat diets on nutrient absorption in pancreatic-insufficient dogs

Background & Aims: Treatment of human exocrine pancreatic insufficiency is suboptimal. This study assessed the effects of bacterial lipase, porcine li pase, and diets on carbohydrate, fat, and protein absorption in pancreatic- insufficient dogs. Methods: Dogs were given bacterial or porcine lipase and 3 diets: a 48% carbohydrate, 27% fat, and 25% protein standard diet; a hig h-carbohydrate, low-fat, and low-protein diet; or a low-carbohydrate, high- fat, and high-protein diet (66%/18%/16% and 21%/43%/36% calories). Results: With the standard diet, coefficient of fat absorption increased dose-depen dently with both lipases (P < 0.05), but move fat was absorbed with porcine lipase (P < 0.05); 600,000 IU of bacterial lipase (240 mg) and 300,000 IU of porcine lipase (18 g) nearly abolished steatorrhea. With 300,000 IU of b acterial lipase or 135,000 IU of porcine lipase, fat absorption was greater with the high-fat and -protein diet (P < 0.05 vs. low-fat and -protein die t). There were no interactions among carbohydrate, fat, and protein absorpt ion. Conclusions: Correcting steatorrhea requires 75 times more porcine tha n bacterial lipase (18 vs. 240 mg). High-fat and high-protein diets optimiz e fat absorption with both enzymes. High-fat diets with bacterial or porcin e lipase should be evaluated in humans with pancreatic steatorrhea.