Measurements of cholesterol turnover, synthesis, and absorption in man, carried out by isotope kinetic and sterol balance methods

We have estimated the daily synthesis of cholesterol in man by measuring the excretion of cholesterol and its conversion products during periods of controlled sterol intake (sterol balance method), using isotopic or chromatographic procedures (or a combination of the two). Estimates of daily synthesis by this method are based on the premise that the subject is in the metabolic steady state; i.e., the synthesis of cholesterol is equal to the balance (or difference) between the intake of cholesterol and the excretion of cholesterol and its products. To test this premise, we carried out sterol balances in 11 patients; simultaneously, after administration of isotopic cholesterol, turnover was calculated according to previously described models (one-pool, two-pool, or isotopic steady state models for the distribution of radioactive cholesterol within various pools of the body). With calculations based on the one-pool model, turnover rates were considerably higher than estimates based on all other models, and reasons are given for considering these to be overestimates. Good agreement was obtained between results calculated from the two-pool model and those based on sterol balance data; neither method is theoretically preferable to the other. However, with the sterol balance method supplemented by isotopic techniques, valid measurements of cholesterol absorption can be obtained; this in turn permits the essential distinction to be made between daily synthesis and daily turnover of cholesterol when the diet contains cholesterol. In addition, the use of chromatographic isolation procedures provides an accurate measurement of the balance of -sitosterol. This in turn permits valid corrections to be made for losses (which may be large) of neutral steroids during intestinal transit; this is a unique advantage of the chromatographic method.