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Introduction Pancreatic exocrine insufficiency (PEI) results from a reduction in pancreatic secretion of enzymes, leading to malabsorption of nutrients, intestinal symptoms, nutritional deficiencies and related comorbidities. The diagnosis of pancreatic exocrine insufficiency should be based on digestive tests, mainly the coefficient of fat absorption (CFA), based on the quantification of 72 h fecal fat excretion (FFE). However, this test is rarely performed in clinical practice. Fecal elastase‐1 (FE‐1) is a simple and widely used alternative. This meta‐analysis evaluates the diagnostic accuracy of fecal elastase‐1 for the diagnosis of PEI diagnosed by CFA or 72h‐FFE. Methods A systematic search of databases was performed to identify studies evaluating fecal elastase‐1 and CFA/FFE for the diagnosis of pancreatic exocrine insufficiency. Inclusion criteria required original studies with data on sensitivity, specificity and other diagnostic metrics. Two independent reviewers performed data extraction and quality assessment using the QUADAS‐2 tool. Pooled sensitivity, specificity, likelihood ratios and diagnostic odds ratio (DOR) were calculated and heterogeneity was assessed using I‐squared tests. Results Thirteen studies with 888 patients were included. Fecal elastase‐1 at a cut‐off of 200 μg/g showed a pooled sensitivity and specificity of 0.94 and 0.69, respectively, with a DOR of 35.27. Lowering the cut‐off to 100 μg/g improved specificity to 0.82 but decreased sensitivity to 0.88. Subgroup analyses showed different diagnostic performance in different clinical contexts, with higher sensitivity in cystic fibrosis (0.98) and higher specificity in chronic pancreatitis (0.81). The positive and negative predictive values are limited in situations with low and high probability of pancreatic exocrine insufficiency, respectively. Conclusions Fecal elastase‐1 is a sensitive and moderately specific diagnostic tool for pancreatic exocrine insufficiency and is suitable for initial screening in high‐risk populations. However, its moderate specificity requires careful interpretation in lower risk settings. FE‐1 is a sensitive and moderately specific diagnostic tool for PEI, suitable for initial screening in high risk populations. However, in low‐risk settings, results should be interpreted with caution due to the potential for false positives.

The incidence of obesity and associated metabolic diseases is increasing globally, adversely affecting human health. Dietary fats, especially triglycerides, are an important source of energy for the body, and the intestine absorbs lipids through a series of orderly and complex steps. A long-term high-fat diet leads to intestinal dysfunction, inducing obesity and metabolic disorders. Therefore, regulating dietary triglycerides absorption is a promising therapeutic strategy. In this review, we will discuss diverse aspects of the dietary triglycerides hydrolysis, fatty acid uptake, triglycerides resynthesis, chylomicron assembly, trafficking, and secretion processes in intestinal epithelial cells, as well as potential targets in this process that may influence dietary fat-induced obesity and metabolic diseases. We also mention the possible shortcomings and deficiencies in modulating dietary lipid absorption targets to provide a better understanding of their administrability as drugs in obesity and related metabolic disorders.

The regular overconsumption of energy‐dense foods (rich in lipids and sugars) results in elevated intestinal nutrient absorption and consequently excessive accumulation of lipids in the liver, adipose tissue, skeletal muscles, and other organs. This can eventually lead to obesity and obesity‐associated diseases such as type 2 diabetes (T2D), non‐alcoholic fatty liver disease (NAFLD), cardiovascular disease, and certain types of cancer, as well as aggravate inflammatory bowel disease (IBD). Therefore, targeting the pathways that regulate intestinal nutrient absorption holds significant therapeutic potential. In this review, we discuss the molecular and cellular mechanisms controlling intestinal lipid handling, their relevance to the development of metabolic diseases, and emerging therapeutic strategies. Graphical Abstract In this review, M. Wit & colleagues discuss the molecular and cellular mechanisms controlling intestinal lipid handling, their relevance to the development of metabolic diseases, as well as emerging therapeutic strategies for the treatment of obesity and obesity‐associated diseases.

Palm oil/olein (PO/POL) is used in infant formulas to imitate the fatty acid profile of human milk (HM) and achieve similar levels of palmitic acid (PA). However, the positions of fatty acids on the triacylglyceride differ between PO/POL and HM, which affect fat absorption and produce unintended physiological consequences. Recent papers have reviewed evidence for physiological benefits of PO/POL and beta-palmitate (sn-2-palmitate) in infant formulas. The aim of the present review is to supplement the assessment of available clinical evidence on the physiological effects of PO/POL formulas in healthy infants. We intend to focus on PO/POL and not on sn-2-palmitate, since the latter was recently extensively reviewed. Clinical evidence supports that PO/POL in infant formulas leads to a lower fat, DHA, palmitate and calcium absorption, and bone mineralization; soft stools; and growth (weight accretion) compared to formulas without PO/POL. Consequently, it seems prudent to be considerate and cautious when adding PO/POL to infant formulas. While HM is the gold standard for infant nutrition, the development of infant formula should be based on achieving positive physiological outcomes, rather than just replicating HM nutrient composition.

Lipids are the most energy‐dense components of the diet, and their overconsumption promotes obesity and diabetes. Dietary fat content has been linked to the lipid processing activity by the intestine and its overall capacity to absorb triglycerides (TG). However, the signaling cascades driving intestinal lipid absorption in response to elevated dietary fat are largely unknown. Here, we describe an unexpected role of the protein kinase D2 (PKD2) in lipid homeostasis. We demonstrate that PKD2 activity promotes chylomicron‐mediated TG transfer in enterocytes. PKD2 increases chylomicron size to enhance the TG secretion on the basolateral side of the mouse and human enterocytes, which is associated with decreased abundance of APOA4. PKD2 activation in intestine also correlates positively with circulating TG in obese human patients. Importantly, deletion, inactivation, or inhibition of PKD2 ameliorates high‐fat diet‐induced obesity and diabetes and improves gut microbiota profile in mice. Taken together, our findings suggest that PKD2 represents a key signaling node promoting dietary fat absorption and may serve as an attractive target for the treatment of obesity. Synopsis We show that upon fat ingestion, Protein Kinase D2 stimulates chylomicron‐mediated triglyceride absorption in the intestine. Targeting PKD2, genetically or with small molecule inhibitors, reduces triglycerides absorption and prevents the development of obesity in mice and presumably in humans. PKD2 enhances chylomicron size and therefore chylomicron‐mediated triglycerides absorption. PKD2 phosphorylates chylomicron‐associated lipoprotein, APOA4. Inhibition of PKD2 diminishes obesity and associated diabetes. PKD2 activity correlates with triglycerides levels in obese patients. Graphical Abstract We show that upon fat ingestion, Protein Kinase D2 stimulates chylomicron‐mediated triglyceride absorption in the intestine. Targeting PKD2, genetically or with small molecule inhibitors, reduces triglycerides absorption and prevents the development of obesity in mice and presumably in humans.

A great number of chemically diverse pancreatic lipase (PL) inhibitors have been identified to tackle obesity; however, very few of them have entered clinical studies. The ethanolic extract of sesame meal is a potent PL inhibitor, and its activity hinges exclusively on two free fatty acids: linoleic acid and oleic acid, which were proven to reduce postprandial triglyceride excursion in rats. Herein, to investigate the clinical efficacy of the sesame meal extract, in a crossover trial, 30 healthy volunteers were randomized to receive the sesame meal extract containing experimental food or placebo along with a high-fat meal. Treatment with the sesame meal extract significantly lowered the incremental postprandial serum triglyceride concentration and reduced the incremental area under the curve (iAUC) by 16.8% (p-value = 0.03) compared to placebo. Significant decreases in postprandial remnant-like lipoprotein particle cholesterol and low-density lipoprotein particles were also observed, whereas high-density lipoprotein cholesterol was increased. These results suggest that treatment with the sesame meal extract significantly reduced the postprandial excursion of triglycerides and improved the lipidemic profile after high dietary fat intake in healthy individuals, indicating the substantial potential of free linoleic acid and oleic acid and natural products rich in these compounds for the management of obesity and related conditions.

•This work focused on the lymphatic system, which is often forgotten but is important from a physiologic point of view.•This study demonstrated that the lymphatic system could be a prime target for the development of new therapeutic strategies in obesity or anorexia. In obesity or anorexia, changes in body composition and mostly alterations in fat mass distribution are observed. The lymphatic system, which is implicated in fat absorption, might play a major role in the phenotype and development of these pathologies. In this study, two mice animal models were used: the high-fat diet model used for obesity and the activity-based anorexia model for anorexia. Lymphatic system marker levels were measured by reverse transcriptase quantitative polymerase chain reaction on the different parts of the intestine. Moreover, the effects of these models were evaluated on lymphatic fat absorption using lipidic tracer. Using these two models, lymphatic system alterations were observed. Indeed, whether in the obesity or the anorectic model, lymphatic fat absorption modifications were noticed with an increase of this parameter in the anorectic mice and a decrease in obesity. Expression levels of lymphatic markers also were impaired in these models. Both obesity and anorectic models induced lymphatic system alterations mainly in the jejunum and ileum parts of the intestine. These alterations are associated with lipid absorption modifications.

Soy protein (SP), egg white protein (EP), and whey protein (WP) at 6% w/w were individually incorporated into the batter of a wheat starch (WS) and wheat gluten (WG) blend (11:1 w/w ratio). Moisture adsorption isotherms of WS and proteins and the viscosity, rheological behavior, and calorimetric properties of the batters were measured. Batter-breaded fish nuggets (BBFNs) were fried at 170 °C for 40 s followed by 190 °C for 30 s, and pick-up of BBFNs, thermogravimetric properties of crust, and fat absorption were determined. The moisture absorption capacity was the greatest for WS, followed by WG, SP, EP, and WP. The addition of SP significantly increased the viscosity and shear moduli (G″, G′) of batter and pick-up of BBFNs, while EP and WP exerted the opposite effect (p < 0.05). SP, EP, and WP raised WS gelatinization and protein denaturation temperatures and crust thermogravimetry temperature, but decreased enthalpy change (ΔH) and oily characteristics of fried BBFNs. These results indicate that hydrophilicity and hydration activity of the added proteins and their interactions with batter matrix starch and gluten reinforced the batter and the thermal stability of crust, thereby inhibiting fat absorption of the BBFNs during deep-fat frying.

Following an application from Mediconomics APS, submitted for authorisation of a health claim pursuant to Article 13(5) of Regulation (EC) No 1924/2006 via the Competent Authority of Denmark, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) was asked to deliver an opinion on the scientific substantiation of a health claim related to calcium sulphate and reduction in body weight. The Panel considers that the food constituent, calcium sulphate, is sufficiently characterised. A reduction in body weight is a beneficial physiological effect for overweight adults. The applicant submitted two human intervention studies investigating the effect of calcium sulphate on body weight. The Panel notes that no conclusions can be drawn from any of the human intervention studies submitted for the scientific substantiation of the claim and that no convincing evidence has been provided for a mechanism by which calcium sulphate could exert the claimed effect in vivo in humans. The Panel concludes that a cause and effect relationship has not been established between the consumption of calcium sulphate and a beneficial physiological effect on body weight under the proposed conditions of use.

The reuse of food industry by-products constitutes one of the essential pillars of the change from a linear to a circular economic model. Drying is one of the most affordable techniques with which to stabilize by-products, making their subsequent processing possible. However, it can affect material properties. The objective of this study was to assess the effect of the drying temperature on the drying kinetics and final quality of the main artichoke processing by-products, bracts and stems, which have never been studied as independent materials. For this purpose, air drying experiments at different temperatures (40, 60, 80, 100 and 120 °C) were carried out. The alcohol insoluble residue (AIR) and the total phenolic content (TPC), antioxidant capacity (AC) and vitamin C (VC) of the fresh and dried samples were determined. The bracts dried faster than the stems, increasing drying rate with temperature. The two by-products presented relatively large amounts of AIR, the content being higher in bracts, but better functional properties in stems. The TPC, AC and VC values of the dried samples decreased in relation to the fresh samples, with the temperatures of 40 °C (bracts) and 120 °C (stems) being the most adequate for the purposes of preserving these characteristics.