Characterization of micronutrients and macronutritional assessment parameters in chronic pancreatitis outpatients and association with exocrine pancreatic insufficiency
Authors
Mathiasen, Anne Sofie Frøkiær ; Jøker-Jensen, Henriette
Term
5. Term (Master thesis)
Education
Publication year
2020
Submitted on
2020-01-02
Pages
28
Abstract
Kronisk pankreatitis er en langvarig betændelse og arvævsdannelse i bugspytkirtlen. Den kan nedsætte produktionen af fordøjelsesenzymer (eksokrin pankreasinsufficiens, EPI) og dermed føre til underernæring. Denne afhandling rummer (1) en metaanalyse, der samler viden om, hvor hyppige vitamin- og mineralmangler og overordnede ernæringsproblemer er blandt ambulante patienter med kronisk pankreatitis, og (2) et tværsnitsstudie af danske ambulante patienter, som estimerer hyppigheden af disse problemer og undersøger, om de hænger sammen med EPI eller enzymbehandling (pancreatic enzyme replacement therapy, PERT), samt hvordan vitaminer/mineraler relaterer sig til den samlede ernæringstilstand. I metaanalysen blev publicerede studier med prævalens for mangler samlet, og variationen mellem studier blev vurderet. I det danske studie blev 137 ambulante patienter med kronisk pankreatitis ved AAUH inkluderet fra januar 2012 til maj 2017. Vurderinger omfattede klinisk undersøgelse, blodprøver, bioelektrisk impedansanalyse (til at estimere kropssammensætning) og funktionelle tests. Vi beregnede prævalenser af mangler og analyserede sammenhænge mellem ernæringstilstand, EPI og/eller PERT, samt mellem mikronæringsstoffer og makroernæringsmål som body mass index (BMI), sarkopeni (lav muskelmasse/styrke) og fasevinkel (et bioimpedansmål for cellers sundhed). Metaanalysen fandt følgende samlede prævalenser: mangel på vitamin A 21 %, vitamin E 31 %, vitamin D 50 % (utilstrækkeligt niveau 68 %), BMI <18,5 kg/m2 hos 11 % og BMI <20 kg/m2 hos 19 %, med betydelig variation mellem studier. I den danske kohorte var de hyppigste fund albuminmangel (29,2 %; albumin er et blodprotein), utilstrækkeligt vitamin D (26,3 %) og mangel (21,9 %), zinkmangel (19,7 %), magnesiumsmangel (16,8 %) og sarkopeni (17,4 %). Der sås sammenhænge med EPI og/eller PERT for vitamin A, vitamin E, vitamin B12, magnesium og sarkopeni. BMI var forbundet med zink. Sarkopeni var forbundet med vitamin E, vitamin B12 og zink, og fasevinkel med vitamin E, magnesium og zink. På tværs af litteraturen varierer rapporterede rater af underernæring ved kronisk pankreatitis betydeligt. I denne danske ambulante population forekom underernæring lavere end i mange publicerede opgørelser. Overordnet var der ingen klar sammenhæng mellem de fleste ernæringsmål og EPI eller PERT. Sammenhænge mellem enkelte mikronæringsstoffer og overordnede ernæringsmål var generelt svage, men zink viste en mere konsekvent sammenhæng og bør undersøges nærmere.
Chronic pancreatitis is a long‑term inflammation and scarring of the pancreas. It can reduce the gland’s production of digestive enzymes (exocrine pancreatic insufficiency, EPI), which may lead to malnutrition. This thesis includes (1) a meta‑analysis that summarizes how common vitamin/mineral deficiencies and broader nutritional problems are among outpatients with chronic pancreatitis, and (2) a cross‑sectional study of Danish outpatients that estimates how often these problems occur and examines whether they relate to EPI or pancreatic enzyme replacement therapy (PERT), and how vitamin/mineral levels relate to overall nutritional status. In the meta‑analysis, published studies reporting prevalence of deficiencies were pooled and between‑study variability was assessed. In the Danish study, 137 outpatients with chronic pancreatitis seen at AAUH were enrolled from January 2012 to May 2017. Assessments included clinical examination, blood tests, bioelectrical impedance analysis (to estimate body composition), and functional tests. We estimated the prevalence of deficiencies and analyzed associations between nutritional status, EPI and/or PERT, and between micronutrients and macronutritional measures such as body mass index (BMI), sarcopenia (low muscle mass/strength), and phase angle (a bioimpedance marker of cell health). Pooled results from the meta‑analysis were: vitamin A deficiency 21%, vitamin E deficiency 31%, vitamin D deficiency 50% (insufficiency 68%), BMI <18.5 kg/m2 in 11% and BMI <20 kg/m2 in 19%, with considerable heterogeneity across studies. In the Danish cohort, the most frequent findings were albumin deficiency (29.2%; albumin is a blood protein), vitamin D insufficiency (26.3%) and deficiency (21.9%), zinc deficiency (19.7%), magnesium deficiency (16.8%), and sarcopenia (17.4%). Associations with EPI and/or PERT were observed for vitamin A, vitamin E, vitamin B12, magnesium, and sarcopenia. BMI was associated with zinc. Sarcopenia was associated with vitamin E, vitamin B12, and zinc, and phase angle with vitamin E, magnesium, and zinc. Across the literature, reported rates of malnutrition in chronic pancreatitis vary widely. In this Danish outpatient sample, malnutrition appeared less common than many published estimates. Overall, most nutritional measures showed no clear link with EPI or PERT. Associations between individual micronutrients and broader nutritional measures were generally weak, but zinc showed a consistent relationship and warrants further study.
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