The 13C-mixed triglyceride breath test in healthy adults: determinants of the 13CO2 response.

Defects in lipolysis due to pancreatic insufficiency can be diagnosed by the mixed triglyceride (MTG) 13CO2 breath test. However, the effects of various test conditions on the 13CO2 response have only been partially elucidated. In healthy adults, we performed the 13CO2 mixed triglyceride breath test and we compared (a) the inter- and intra-individual variation in the 13CO2 response; (b) the effect of two different test meals; (c) the effect of an additional meal during the test; and (d) the effect of physical exercise during the test. Upon repeating the test in the same individual (test meal cream), repeatability coefficients were large, with respect to either time to maximum 13C excretion rate (3.8 h). maximum 13C excretion rate (4.9% 13C dose h-1) or cumulative recovery of 13C over the 9-h study period (22.7% 13C dose). The cumulative 13C expiration over 9 h obtained with the test meal composed of cream was quantitatively similar to that obtained with bread and butter: 42.2 +/- 8.4% and 47.7 +/- 6.3% respectively. Fasting for 9 h during the test resulted in similar 13C expiration rates and cumulative 13C expiration (43.4% +/- 7.2%) when compared with consumption of an additional meal 3 h after the start of the test (38.3 +/- 5.3%). The 13CO2 response increased in five out of seven subjects, but decreased in the other two, when moderate exercise was performed (bicycle ergometer, 50 W for 5 h). We conclude that the repeatability of the MTG test in healthy adults is low. The present results indicate that a solid and a liquid test meal, containing a similar amount of fats, give similar cumulative 13CO2 responses, and that stringent prolonged fasting during the test is unnecessary. Standardization of physical activity seems preferable, since the unequivocal effects of moderate exercise on the 13CO2 response were observed in the individuals studied.