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Pancreatic size in protein energy malnutrition: a predictor of nutritional recovery

European Journal of Clinical Nutrition volume 59, pages 467–473 (2005)Cite this article

Abstract

Background:

Pancreatic exocrine dysfunction has been frequently recorded in protein energy malnutrition (PEM) because the pancreas requires optimal nutrition for enzyme synthesis. This pancreatic enzyme insufficiency may play a role in the continuation of PEM.

Objective:

This study was designed to assess the pancreatic head size and exocrine pancreatic functions, namely serum amylase and lipase, in PEM and its subtypes and correlate any defect present with the various clinical and laboratory data of the PEM patients with special emphasis on the effect of nutritional rehabilitation.

Patients and methods:

A total of 33 cases of PEM; 15 marasmus, 10 kwashiorkor (KWO) and eight marasmic kwashiorkor (MKWO) were recruited from Ain Shams University children's hospital, together with 12 matched controls. The mean age of patients was 11.87±7.8 months and that of the controls was 14.83±7.7 months. Detailed history taking and thorough clinical examination with special emphasis on anthropometric measurements were taken for each studied infant as well as laboratory investigations which included; complete blood count, liver and kidney functions and serum amylase and lipase. Ultrasonographic assessment of pancreatic head size was performed for the cases and controls. Nutritional rehabilitation program was carried out for 3–6 months followed by reassessment of the cases.

Results:

The pancreatic head size values were significantly lower in all subtypes of PEM (1.52±0.6, 2.73±0.12 and 3.00±0.54 cm3 in the marasmus, KWO and MKWO respectively) compared to the controls (5.13±2.33 cm3). The serum amylase and lipase were also significantly lower in all subgroups of PEM when compared to the controls with significant improvement following nutritional rehabilitation coupled by a significant increase in pancreatic head size too. No significant differences were recorded when we compared the subgroups together except for a significant higher rate of change in serum amylase in edematous patients compared to nonedematous ones. The length of nutritional rehabilitation period, age of the patient, weight and serum albumin were the most determinant factors for pancreatic head size as evident from the multiple regression analysis study.

Conclusion:

The potentially correctable exocrine pancreatic insufficiency in cases of PEM should be carefully thought of when planning the nutritional rehabilitation program for such patients as it could be responsible for the serious continued morbidity issues that they face. We thus recommend that estimation of pancreatic head size and exocrine function should be included in the evaluation of PEM patients and they could also be used as a prognostic parameter.

Sponsorship:

The patients enrolled were among those admitted and managed freely in the children's Hospital Faculty of Medicine Ain Shams University, including the use of the ultrasound apparatus, while the kits have been purchased by authors who contributed in financing the study.

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References

  • Barbezat GO & Hansen JDL (1968): The exocrine pancreas and protein-calorie malnutrition. Pediatrics 42, 77–92.

    CAS  PubMed  Google Scholar 

  • Brooks SE & Golden MH (1992): The exocrine pancreas in kwashiorkor and marasmus. Light and electron microscopy. West Indian Med. J. 41, 56–60.

    CAS  PubMed  Google Scholar 

  • Cleghorn GJ, Erlich J, Bowling FG, Forrest Y, Greer R, Holt TL & Shepherd RW (1991): Exocrine pancreatic dysfunction in malnourished Australian aboriginal children. Med. J. Aust. 154, 45–48.

    CAS  PubMed  Google Scholar 

  • Cuntz U, Frank G, Lehnert P & Fichter M (2000): Interrelationships between the size of the pancreas and the weight of patients with eating disorders. Int. J. Eat. Disord. 27, 297–303.

    Article  CAS  Google Scholar 

  • Davis JNP (1948): The essential pathology of kwashiorkor. Lancet 1, 317–320.

    Article  Google Scholar 

  • Heird WC (2004): Food insecurity, hunger and undernutrition. In: Nelson, Textbook of Pediatrics, eds RE Behrman, RM Kliegman & HB Jenson, 17th edn, Chapter 42, pp 167–173. Philadelphia, PA: W.B. Saunders Company.

    Google Scholar 

  • Klein B, Foreman JA & Searcy RL (1970): New chromogenic substrate for determination of serum amylase activity. Clin. Chem. 16, 32–38.

    CAS  PubMed  Google Scholar 

  • Lott JA, Patel ST, Sawhney AK, Kazmierczak SC & Love Jr JE (1986): Assays of serum lipase: analytical and clinical considerations. Clin. Chem. 32, 1290–1302.

    CAS  PubMed  Google Scholar 

  • Mohamed-Bendaka K, Bellevillle J & Prost J (1993): Comparative changes between pancreas and pancreatic juice digestive enzyme contents during nutritional rehabilitation following severe protein malnutrition in the rat. Br. J. Nutr. 69, 83–96.

    Article  Google Scholar 

  • Nicholson JF & Pesce MA (2004): Reference ranges for laboratory tests and procedures. In: Nelson, Textbook of Pediatrics, eds RE Behrman, RM Kliegman & HB Jenson, 17th edn, Chapter 710, pp 2396–2427. Philadelphia, PA: W.B. Saunders Company.

    Google Scholar 

  • Prost J & Belleville J (1987): Influence of protein malnutrition followed by a balanced refeeding on the synthesis level of pancreatic hydrolases in growing rats. CR Seances Soc. Biol. Fil. 181, 407–414.

    CAS  Google Scholar 

  • Sauniere JF & Sarles H (1988): Exocrine pancreatic function and protein-calorie malnutrition in Dakar and Abidjan (West Africa): silent pancreas insufficiency. Am. J. Clin. Nutr. 48, 1233–1238.

    Article  CAS  Google Scholar 

  • Stransky E & Dauis-Lawas DF (1950): On kwashiorkor (infantile pellagra, malignant malnutrition). Ann. Pediatr. 174, 226–246.

    CAS  Google Scholar 

  • Thompson MD & Trowell HC (1952): Pancreatic enzyme activity in duodenal contents of children with a type of kwashiorkor. Lancet 1, 1031–1035.

    Article  CAS  Google Scholar 

  • Wellcome T (1970): Wellcome trust working study: committee on nutrition. Lancet 2, 302.

    Google Scholar 

  • WHO (1999): Management of Severe Malnutrition: A Manual for Physicians and Other Senior Health Workers. Geneva: World Health Organization.

    Google Scholar 

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Authors and Affiliations

  1. Department of Pediatrics, Faculty of Medicine, Ain Shams University, Abbassia, Cairo, Egypt

    M A El-Hodhod & M F Nassar

  2. Department of Radiology, Faculty of Medicine, Ain Shams University, Abbassia, Cairo, Egypt

    O A Hetta

  3. Division of Chemistry and Biological Research, National Center for Social and Criminological Research, Cairo, Egypt

    S M Gomaa

Authors
  1. M A El-Hodhod
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  2. M F Nassar
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  3. O A Hetta
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  4. S M Gomaa
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Corresponding author

Correspondence to M F Nassar.

Additional information

Guarantors: MA El-Hodhod and MF Nassar.

Contributors: MAE-H established the main idea of the study, coordinated and supervised all its steps, as well as editing the finalmanuscript, while MFN helped establishing the study design, carried out the practical part (patient enrollment and follow-up), data interpretation and editing the final manuscript. OAH performed the ultrasonographic evaluation of the cases and SMG did the laboratory workup, and they both helped in data interpretation and editing.

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El-Hodhod, M., Nassar, M., Hetta, O. et al. Pancreatic size in protein energy malnutrition: a predictor of nutritional recovery. Eur J Clin Nutr 59, 467–473 (2005). https://doi.org/10.1038/sj.ejcn.1602053

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