Malnutrition after pancreatic enzyme replacement therapy in chronic pancreatitis: Risk factors in real world practice

Arutla, Madhulika; Sarkar, Subhaleena; Unnisa, Misbah; Sarkar, Priyanka; Raj, Merlin Annie; Mrudula, M.R.; Deepika, G.; Pasham, Sudhir; Jakkampudi, Aparna; Prasanna, Ambika; Reddy, D. Nageshwar; Talukdar, Rupjyoti

doi:10.1016/j.pan.2020.11.027

Cited by 7 publications

(2 citation statements)

References 24 publications

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“…Weight loss has repeatedly been observed in patients with CP and related to impaired nutritional status ( 28 – 32 ). While weight loss has commonly been linked to low BMI, a relation to altered body composition in malnourished subjects with CP has only been shown in a single investigation ( 31 ). In agreement with our results, this study found lower fat and muscle reserves, indicated by anthropometric measures, in malnourished subjects.…”

Section: Discussionmentioning

confidence: 99%

Malnutrition Is Highly Prevalent in Patients With Chronic Pancreatitis and Characterized by Loss of Skeletal Muscle Mass but Absence of Impaired Physical Function

et al. 2022

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Background/AimsPatients with chronic pancreatitis (CP) have an increased risk of malnutrition, a condition linked to reduced muscle mass and physical performance. We have investigated the risk factors, phenotypic presentation, and health implications associated with malnutrition in CP.Materials and MethodsIn a multicenter cross-sectional study we recruited patients with confirmed CP and healthy volunteers as a control group. Malnutrition was diagnosed according to the criteria proposed by the Global Leadership Initiative on Malnutrition. We performed detailed examinations of body composition and physical function as well as testing of routine blood parameters and markers of inflammation.ResultsWe included 66 patients [mean (±SD) age: 56.0 (±14.5) years; 51 males] and an equal number of age- and sex-matched controls. Moderate malnutrition was diagnosed in 21% (n = 14) and severe malnutrition in 42% (n = 28) of patients. Besides weight loss malnourished patients showed lower fat and skeletal muscle mass compared to both non-malnourished subjects and healthy controls. Only in severe malnutrition, blood parameters reflected elevated inflammation and reduced muscle reserves. Handgrip strength in patients did not differ by nutritional status but there was a significant correlation (rho = 0.705, p < 0.001) with skeletal muscle mass. Although 20 patients (30%) had pathologically reduced skeletal muscle mass, only two individuals (3%) had sarcopenia with concomitantly reduced handgrip strength.ConclusionMalnutrition is a frequent complication of CP characterized by loss of skeletal muscle mass. As this condition becomes evident only at an advanced stage, regular testing for altered body composition is recommended. Suitable biomarkers and the link between loss of muscle mass and physical function require further investigation.Clinical Trial Registration[https://clinicaltrials.gov/ct2/show/NCT04474743], identifier [NCT04474743].

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Section: Discussionmentioning

confidence: 99%

Malnutrition Is Highly Prevalent in Patients With Chronic Pancreatitis and Characterized by Loss of Skeletal Muscle Mass but Absence of Impaired Physical Function

et al. 2022

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“…In the latter study, poor adherence to PERT was found to be a risk factor for nonimprovement. In a more recent observational study, we evaluated 377 patients who were divided into three groups (those on regular PERT, irregular PERT, and no PERT for at least 3 months) [22 ▪▪ ]. Although it was not surprising that 31.5% of patients who did not take PERT had malnutrition, it was intriguing that even over a third of patients who were compliant to PERT continued to have malnutrition.…”

Section: Pancreatic Exocrine Replacement Therapy: How Effective Is It?mentioning

confidence: 99%

Optimizing nutrition in chronic pancreatitis

Talukdar

Unnisa

2022

Current Opinion in Gastroenterology

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Purpose of reviewThis review aims to discuss recent developments in the nutritional management in chronic pancreatitis.Recent findingsNutritional assessment should be comprehensive and include dietary history, anthropometry, and biochemical nutritional parameters. Micronutrients should be evaluated at least yearly and dual-energy X-ray absorptiometry (DEXA) at every 2-yearly intervals. Studies on pancreatic enzyme replacement therapy (PERT) have primarily evaluated coefficient of fat excretion (CFA), coefficient of nitrogen excretion (CNA), and stool weight. Two RCTs, in which patients were treated with PERT for 7 days in a blinded manner and subsequently extended for 6–12 months in an open-label manner, showed improvement in nutritional parameters. However, two subsequent RCTs failed to show any benefit, and the most recent observational study demonstrated persistence of malnutrition even after PERT. The reason for the latter findings were nonadherence to PERT and poor oral intake of calories. Therefore, it is essential to educate the patients on adherence, counsel on taking high-protein, high-calorie diet, and supplement nutrients in those with inadequate oral intake. Other associated manifestations, such as diabetes and related complications, and anxiety/depression could also contribute to malnutrition directly or indirectly, and should, therefore, be adequately managed.SummaryNutritional assessment should be performed meticulously. Nutritional therapy should not be restricted to only PERT and nutritional supplementation, but should also include dietary counselling and disease related education.

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Ein Ersatz der Pankreasenzyme ist nützlich, muss aber überwacht werden

Bublak

2021

MMW - Fortschritte der Medizin

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Malnutrition after pancreatic enzyme replacement therapy in chronic pancreatitis: Risk factors in real world practice

Cited by 7 publications

References 24 publications

Malnutrition Is Highly Prevalent in Patients With Chronic Pancreatitis and Characterized by Loss of Skeletal Muscle Mass but Absence of Impaired Physical Function

Malnutrition Is Highly Prevalent in Patients With Chronic Pancreatitis and Characterized by Loss of Skeletal Muscle Mass but Absence of Impaired Physical Function

Optimizing nutrition in chronic pancreatitis

Ein Ersatz der Pankreasenzyme ist nützlich, muss aber überwacht werden

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