The small bowel has traditionally been considered a simple organ for the transport of food-stuffs. Although the function of nutrient delivery is vital, the digestive and absorptive phases of fat were poorly understood until the past two decades. Moreover, the small bowel was not thought to have any modulating transport properties nor a role in the genesis of chronic diseases such as atherosclerosis. Given its enormous capacity to transform nutrients and to synthesize atherogenic proteins and gastro-intestinal peptides, the intestinal epithelium plays a key role in a number of metabolic pathways. The aim of the brief review is to provide an update on recent advances in our understanding of the absorption of dietary lipids with emphasis on the role and contribution of key proteins to malabsorptive syndromes as well as hyperlipidemic syndromes and eventually to atherosclerosis.