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However, most fat digestion takes place in the small intestine via pancreatic enzymes and bile salts. Emulsification of fat by bile acids facilitates enzymatic action, breaking down triglycerides into free fatty acids and monoglycerides, which are then able to be absorbed by enterocytes. Fat malabsorption can result from various underlying conditions, such as exocrine pancreatic insufficiency, bile acid disorders, or intestinal diseases. The clinical manifestations of fat malabsorption include steatorrhea, malnutrition, and deficiencies of fat\u2010soluble vitamins. Diagnostic approaches involve assessing fecal fat levels, imaging studies, and various functional tests to identify the specific etiology. This review article will describe the normal physiologic process of fat digestion and absorption and discuss various pathophysiology that can lead to fat malabsorption within the gastrointestinal tract as well as their respective diagnostic testing modalities. Effective digestion of fat is essential for overall health, because it allows for absorption of many essential nutrients, plays an integral role in cellular and structural function, and supplies energy to the body. When this is dysfunctional, disorders of malabsorption can occur. This article will give a brief overview of the physiologic process of fat digestion and absorption in healthy individuals as well as review important pathophysiology that can lead to fat malabsorption within the gastrointestinal tract and current diagnostic testing modalities.<\/jats:p>","DOI":"10.1002\/ncp.11130","type":"journal-article","created":{"date-parts":[[2024,3,2]],"date-time":"2024-03-02T02:35:24Z","timestamp":1709346924000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":46,"title":["Fat digestion and absorption: Normal physiology and pathophysiology of malabsorption, including diagnostic testing"],"prefix":"10.1002","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9544-7889","authenticated-orcid":false,"given":"Endashaw","family":"Omer","sequence":"first","affiliation":[{"name":"Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine University of Louisville Louisville Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Chiodi","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Louisville Louisville Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,3]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.aninu.2021.09.010"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpendo.90899.2008"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1152\/advan.00094.2009"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.2005.065946"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgast-2021-000643"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.foodres.2023.112785"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gastha.2022.11.008"},{"issue":"5","key":"e_1_2_8_9_1","first-page":"121","article-title":"Pancreatic enzyme replacement therapy: a concise review","volume":"20","author":"Brennan GT","year":"2019","journal-title":"JOP"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2023.07.007"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPA.0000000000000237"},{"issue":"3","key":"e_1_2_8_12_1","first-page":"150","article-title":"The pathophysiology of malabsorption","volume":"30","author":"Keller J","year":"2014","journal-title":"Viszeralmedizin"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.2147\/CEG.S168266"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2013.11.039"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCG.0b013e31829f56e7"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12885-018-4439-x"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pan.2016.09.001"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2010.04437.x"},{"issue":"2","key":"e_1_2_8_19_1","first-page":"151","article-title":"Pancreatic exocrine insufficiency after pancreatic surgery","volume":"58","author":"Goess R","year":"2016","journal-title":"Panminerva Med"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2015.08.046"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1542-3565(04)00607-X"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/0016-5085(87)90848-1"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.5604\/01.3001.0010.5493"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11894-999-0022-6"},{"key":"e_1_2_8_25_1","unstructured":"VuMK. 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