Effectivity of microscopic test as a simple diagnostic method to detect fat malabsorption in children

  • Ariani Dewi Widodo Department of Pediatrics, Harapan Kita Women and Children Hospital, Jakarta, Indonesia
  • Muzal Kadim Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia https://orcid.org/0000-0003-2512-255X
  • Ina Susianti Timan Department of Clinical Pathology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Nuraini Irma Susanti Department of Pediatrics, Fatmawati General Hospital, Jakarta, Indonesia
  • Fatima Safira Alatas Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia https://orcid.org/0000-0003-1299-7154
  • Agus Firmansyah Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Keywords: children, feces, lipids, malabsorption syndromes
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BACKGROUND Lipid malabsorption causes many health problems, for example stunting, a major worldwide issue. There has not been any assessment on the effectivity of lipid microscopic test in diagnosing lipid malabsorption. This research was aimed to study the effectivity of lipid microscopic test in detecting lipid malabsorption in children.

METHODS This was a cross-sectional diagnostic study that evaluated the effectivity of lipid microscopic test using Sudan III against steatocrit test as the gold standard in diagnosing lipid malabsorption. The study was done in 68 children aged 6â60 months in Cipto Mangunkusumo Hospital, Jakarta. Results of lipid microscopic test were compared with that of steatocrit test among children with lipid malabsorption and normal children. The primary endpoints of this study are the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).

RESULTS A total of 68 children consisting of 41 boys and 27 girls were included, with a median age of 14.3 months. The most frequently found stool consistency was mushy (50%). The most common result of microscopic test, found in 42% of subjects, was positive 1. Sensitivity, specificity, PPV, and NPV of lipid microscopic test were 49.15%, 66.67%, 90.63%, and 16.67%, respectively.

CONCLUSIONS Lipid microscopic test has a moderate sensitivity in diagnosing fat malabsorption and needs to be complemented with other methods such as steatocrit.


  1. World Health Organization. Reducing stunting in children: equity considerations for achieving the global nutrition targets 2025 [Internet]. World Health Organization; 2018 [cited 2018 Nov 10]. Available from: https://www.who.int/nutrition/publications/severemalnutrition/reducing-stunting-children-equity/en/.

  2. Owino V, Ahmed T, Freemark M, Kelly P, Loy A, Manary M, et al. Environmental enteric dysfunction and growth failure/stunting in global child health. Pediatrics. 2016;138(6):e20160641. https://doi.org/10.1542/peds.2016-0641

  3. Amann ST, Josephson SA, Toskes PP. Acid steatocrit: a simple, rapid gravimetric method to determine steatorrhea. Am J Gastroenterol. 1997;92(12):2280-4.

  4. Satari HI. Steatocrit: a simple method for detecting fat malabsorption [master's thesis]. Jakarta (Indonesia): Universitas Indonesia; 1991. Indonesian.

  5. Drummey GD, Benson JA, Jones CM. Microscopical examination of the stool for steatorrhea. N Eng J Med. 1961;264:85-7. https://doi.org/10.1056/NEJM196101122640207

  6. Satari HI. Steatocrite: a simple method to diagnose fat malabsorption (a preliminary study) [thesis]. Jakarta (Indonesia): Universitas Indonesia; 1991. Indonesian.

  7. Richardson AJ, Montgomery P. The Oxford-Durham Study: a randomized, controlled trial of dietary supplementation with fatty acids in children with developmental coordination disorder. Pediatrics. 2005;115(5):1360-6. https://doi.org/10.1542/peds.2004-2164

  8. Berstad A, Erchinger F, Hjartholm AS. Fecal fat determination with a modified titration method. Scand J Gastroenterol. 2010;45(5):603-7. https://doi.org/10.3109/00365521003611299

  9. van de Kamer JH, Ten Bokkel Huinink H, Weyers HA. Rapid method for the determination of fat in feces. J Biol Chem. 1949;177(1):347-55.

  10. Ditchburn RK, Smith AH, Hayter CJ. Use of unabsorbed radioactive marker substances in a re-assessment of the radioactive triolein test of fat absorption. J Clin Pathol. 1971;24(6):506-14. https://doi.org/10.1136/jcp.24.6.506

  11. Teh LB, Stopard M, Anderson S, Grant A, Quantrill D, Wilkinson RH, et al. Assessment of fat malabsorption. J Clin Pathol. 1983;36(12):1362-6. https://doi.org/10.1136/jcp.36.12.1362

  12. Maranhão HS, Wehba J. Steatocrit and Sudan III in the study of steatorrhea in children: comparison with the Van de Kamer method. Arq Gastroenterol. 1995;32(3):140-5.

  13. Walker BE, Kelleher J, Davies T, Smith CL, Losowsky MS. Influence of dietary fat on fecal fat. Gastroenterology. 1973;64(2):233-9.

  14. Yussac MA, Cahyadi A, Putri AC, Dewi AS, Khomaini A, Bardosono S, et al. The prevalence of obesity in children aged 4-6 years and its relationship with intake and diet. Maj Kedokt Indon. 2007;57(2):47-53. Indonesian.

  15. Atmarita, Jahari AB, Sudikno, Soekatri M. Sugar, salt and fat intake in Indonesia: 2014 individual food consumption survey (SKMI) analysis. Gizi Indon. 2016;39(1):1-14. https://doi.org/10.36457/gizindo.v39i1.201

  16. Bijoor AR, Geetha S, Venkatesh T. Faecal fat content in healthy adults by the 'acid steatocrit method'. Indian J Clin Biochem. 2004;19(2):20-2. https://doi.org/10.1007/BF02894252

  17. Nakamura T, Takeuchi T. Pancreatic steatorrhea, malabsorption, and nutritional biochemistry: a comparison of Japanese, European, and American patients with chronic pancreatitis. Pancreas. 1997;14(4):323-3. https://doi.org/10.1097/00006676-199705000-00001

  18. Phuapradit P, Narang A, Mendonca P, Harris DA, Baum JD. The steatocrit: a simple method for estimating stool fat content in newborn infants. Arch Dis Child. 1981;56(9):725-7. https://doi.org/10.1136/adc.56.9.725

  19. Van den Neucker A, Pestel N, Tran TM, Forget PP, Veeze HJ, Bouquet J, et al. Clinical use of acid steatocrit. Acta Paediatr. 1997;86(5):466-9. https://doi.org/10.1111/j.1651-2227.1997.tb08914.x

  20. 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;19(3):299-303. https://doi.org/10.1097/00005176-199410000-00007

  21. Sugai E, Srur G, Vazquez H, Benito F, Mauriño E, Boerr LA, et al. Steatocrit: a reliable semiquantitative method for detection of steatorrhea. J Clin Gastroenterol. 1994;19(3):206-9. https://doi.org/10.1097/00004836-199410000-00007

  22. Tran M, Forget P, Van den Neucker A, van Kreel B. Improved steatocrit results obtained by acidification of fecal homogenates are due to improved fat extraction. J Pediatr Gastroenterol Nutr. 1996;22(2):157-60. https://doi.org/10.1097/00005176-199602000-00006

  23. Ghosh SK, Littlewood JM, Goddard D, Steel AE. Stool microscopy in screening for steatorrhea. J Clin Path. 1977;30(8):749-53. https://doi.org/10.1136/jcp.30.8.749

  24. Ramakrishna BS. The steatocrit as a measure of fecal fat excretion: uses and pitfalls. Indian J Gastroenterol. 2009;28(6):195-7. https://doi.org/10.1007/s12664-009-0076-2

How to Cite
Widodo AD, Kadim M, Timan IS, Susanti NI, Alatas FS, Firmansyah A. Effectivity of microscopic test as a simple diagnostic method to detect fat malabsorption in children. Med J Indones [Internet]. 2019Dec.13 [cited 2020Oct.21];28(4):338-44. Available from: http://mji.ui.ac.id/journal/index.php/mji/article/view/3640
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