Recovery of Exocrine Pancreatic Function in Adult Protein-calorie Malnutrition

Tandon, B. N.; Banks, Peter A.; George, PrayGod; Sama, Sonu; Ramachandran, K; Gandhi, Paulin

doi:10.1016/s0016-5085(70)80037-3

Cited by 40 publications

(8 citation statements)

References 13 publications

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“…Table 1 includes studies reporting the association between malnutrition in young children and exocrine (n 13) (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28) , or endocrine (n 19) (29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47) , pancreatic function either concurrently or after follow-up, most of which was short term. Table 2 includes studies reporting the association between malnutrition in older children or adults, mainly AN patients, and exocrine (n 3) (48)(49)(50) or endocrine (n 15) (51)(52)(53)(54)(55)(56)(57)(58)(59)(60)(61)(62)…”

Section: Articles Included and Excludedmentioning

confidence: 99%

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Association of postnatal severe acute malnutrition with pancreatic exocrine and endocrine function in children and adults: a systematic review

et al. 2022

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Severe acute malnutrition may lead both concurrently and subsequently to malabsorption and impaired glucose metabolism from pancreatic dysfunction. We conducted a systematic review to investigate the associations of current and prior postnatal wasting malnutrition with pancreatic endocrine and exocrine functions in humans. We searched PubMed, Google Scholar, Web of Science, and reference lists of retrieved articles, limited to articles in English published before February 1, 2022. We included 68 articles, mostly cross-sectional or cohort studies from 29 countries including 592,530 participants, of which 325,998 were from a single study. Many were small clinical studies from decades ago and rated poor quality. Exocrine pancreas function, indicated by duodenal fluid or serum enzymes, or fecal elastase, was generally impaired in malnutrition. Insulin production was usually low in malnourished children and adults. Glucose disappearance during oral and intravenous glucose tolerance tests was variable. Upon treatment of malnutrition, most abnormalities improved but frequently not to control levels. Famine survivors studied decades later showed ongoing impaired glucose tolerance with some evidence of sex differences. The similar findings from anorexia nervosa, famine survivors, and poverty- or infection-associated malnutrition in low- and middle-income countries (LMICs) lend credence to results being due to malnutrition itself. Research using large, well-documented cohorts and considering sexes separately, is needed to improve prevention and treatment of exocrine and endocrine pancreas abnormalities in LMICs with a high burden of malnutrition and diabetes.

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Section: Articles Included and Excludedmentioning

confidence: 99%

“…There were thirty-two cross-sectional studies, (18,22,24,27,29,32,(34)(35)(36)39,42,43,48,51,53,54,57,58,60,(66)(67)(68)71,72,(75)(76)(77)(78)(79)(81)(82)(83) , twenty-seven cohort studies, (17,(19)(20)(21)28,30,31,33,37,41,46,47,49,50,52,55,56,59,61,(63)(64)…”

Section: Study Design and Participants Characteristicsmentioning

confidence: 99%

Association of postnatal severe acute malnutrition with pancreatic exocrine and endocrine function in children and adults: a systematic review

et al. 2022

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“…Another theorized mechanism is deficiency of amino acids, which leads to reduced protein synthesis for pancreatic enzymes. This mechanism is also backed up by the fact that correction of deficiencies alleviates PEI in CD patients[ 64 ]. Another hypothesis, but probably of less significance, is that of structural changes in the pancreatic parenchyma (acinar atrophy, fibrosis) seen in advanced malnutrition[ 65 ].…”

Section: Exocrine Pancreatic Insufficiency and CDmentioning

confidence: 99%

Pancreatic involvement in celiac disease

Balaban¹,

Enache²,

Ciochina³

et al. 2022

WJG

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Celiac disease (CD) is well recognized as a systemic, chronic autoimmune disease mainly characterized by gluten-sensitive enteropathy in genetically predisposed individuals but with various extraintestinal features. One of the affected organs in CD is the pancreas, consisting of both endocrine and exocrine alterations. Over the last decades there has been increasing interest in the pancreatic changes in CD, and this has been reflected by a great number of publications looking at this extraintestinal involvement during the course of CD. While pancreatic endocrine changes in CD, focusing on type 1 diabetes mellitus, are well documented in the literature, the relationship with the exocrine pancreas has been less studied. This review summarizes currently available evidence with regard to pancreatic exocrine alterations in CD, focusing on risk of pancreatitis in CD patients, association with autoimmune pancreatitis, prevalence and outcomes of pancreatic exocrine insufficiency in newly diagnosed and gluten-free diet treated CD patients, and the link with cystic fibrosis. In addition, we discuss mechanisms behind the associated pancreatic exocrine impairment in CD and highlight the recommendations for clinical practice.

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“…First, deficiencies of essential amino acids are common in PCM (3) and would be expected to impair protein synthesis of digestive enzymes. Evidence to support this mechanism is that dietary therapy to replete these deficiencies quickly restores pancreatic exocrine function in most patients (3,44,57,62,63). Due to the typical prompt restoration of exocrine pancreatic function with dietary therapy, it seems unlikely that EPI in most patients with PCM is directly related to pancreatic morphological changes, described as pancreatic acinar atrophy which may progress to fibrosis (see reviews (44,63)).…”

Section: Malnutritionmentioning

confidence: 99%

Exocrine Pancreatic Insufficiency and Pancreatitis Associated with Celiac Disease

DiMagno¹

Pancreapedia: Exocrine Pancreas Knowledge Base

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Background/Objectives: The aim of this review is to provide a valuable and focused source of information for understanding and evaluating pancreatic manifestations of patients with celiac disease (CD). Methods: The review encompasses the current diagnostic criteria of CD and disease related prevalence and mechanisms of secondary exocrine pancreatic insufficiency (EPI) and the risk and mechanisms of pancreatitis. Topics also include the prevalence of CD in idiopathic pancreatitis, when to investigate and treat other causes of steatorrhea, particularly EPI with pancreatic enzyme replacement therapy (PERT). Conclusions: In "classical" CD the prevalence of EPI ranges 0-77.8%, on the basis of secretagogue and test meal evoked direct pancreatic function tests. Severe EPI (sufficient to cause steatorrhea) is uncommon, ranging in prevalence from 0-18%, and is usually reversible. Major mechanisms of EPI in CD include disruption of enteric mediated hormone secretion, luminal dilution of digestive enzymes and bile acids, malnutrition and immune mediated inflammation. CD associates with an increased risk of developing acute pancreatitis and chronic pancreatitis. Conversely, there is likely an unrecognized incidence of CD in idiopathic pancreatitis. In patients with CD and persistent malabsorption or weight loss despite a gluten free diet (GFD), EPI should be one of several considerations and a trial of PERT offered to patients.

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Recovery of Exocrine Pancreatic Function in Adult Protein-calorie Malnutrition

Cited by 40 publications

References 13 publications

Association of postnatal severe acute malnutrition with pancreatic exocrine and endocrine function in children and adults: a systematic review

Association of postnatal severe acute malnutrition with pancreatic exocrine and endocrine function in children and adults: a systematic review

Pancreatic involvement in celiac disease

Exocrine Pancreatic Insufficiency and Pancreatitis Associated with Celiac Disease

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