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Journal of Pediatric Gastroenterology & Nutrition:
doi: 10.1097/MPG.0000000000000315
Letters to the Editor

Increased Fecal Fat and Protein Intolerance

Tormo, Ramon

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Unitat de Gastroenterologia i Nutrició, Barcelona, Spain

To the Editor: I congratulate Moore et al on their article “Relations between feeding intolerance and stress biomarkers in preterm infants” (1). It is of paramount importance to identify intolerance to enteral feeding to decrease the risk of necrotizing enterocolitis.

The authors predicted necrotizing enterocolitis using allostatic stress by measuring biomarkers from cord blood, saliva, and urine (8-hydroxydeoxyguanosine enzyme immunoassay). This approach is, however, expensive and slow, and requires specially trained staff; consequently, results arrive too late to protect an infant's health.

The fecal fat test is quick, accurate, and easy to perform. Normal fecal fat content is approximately 5%. Increased fecal fat content is a biomarker of food intolerance in early infancy once cystic fibrosis has been ruled out, and should alert the medical team to switch to a hydrolyzed or elemental formula, decreasing the risk of developing a necrotizing enterocolitis.

At the European Society for Clinical Nutrition and Metabolism meeting in Gotheburg (2011), we showed that fecal fat content can be determined in 2 minutes using near-infrared spectroscopy (2). The technique is accepted by other authors (3,4) and requires no special training. Its cost is well under $1 per test.

Dare I say that veterans like me believe we are approaching a time when tonsillitis is diagnosed not by looking at the throat but by ordering an MRI scan?

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1. Moore TA, Wilson ME, Scmid KK, et al. Relations between feeding intolerance and stress biomarkers in preterm infants. J Pediatr Gastroenterol Nutr 2013; 57:356–362.

2. Tormo R, Segurola H, Cardenas G, et al. Benefits of a hydrolysed rice protein formula in no IgE cow's milk protein allergy infants. Clin Nutr 2011; 6:221.

3. Benini L, Caliari S, Guidi BC, et al. Near infrared spectroscopy for faecal fat measurement: comparison with conventional gravimetric and titrimetric methods. Gut 1989; 30:1344–1347.

4. Stein J, Purschian B, Bieniek U, et al. Validation of near-infra-red reflectance analysis (NIRA) for the assessment of fecal fat, nitrogen and water. A new approach to malabsorption syndromes. Paper presented at: Annual Meeting of the American Gastroenterological Association (AGA); May 10–13, 1992; San Francisco, CA.

© 2014 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,


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