Nutritional status in patients with chronic pancreatitis


Cite item

Full Text

Abstract

Chronic pancreatitis (CP) is an inflammatory disease of the pancreas, accompanied by damage to the functioning parenchyma and ducts to develop irreversible structural changes (fibrosis, calcification) and irreparable loss of the endocrine and exocrine functions of this organ. Maldigestion is a typical outcome of CP of any etiology with a long-term history. Fat malabsorption is considered as a basis for malnutrition in patients with CP. The severity of malnutrition in patients with CP correlates with three major pathogenetic factors: primary nutrient deficiency, pancreatic maldigestion and secondary malabsorption syndrome (nutrient loss), hypermetabolism that is caused by an inflammatory process in the pancreas and that determines the severity of the disease. Malnutrition in patients with CP is not just a complication of this disease, but has an important impact on its course. Patients with severe malnutrition are noted to have the significantly lower activity of pancreatic enzymes in the duodenal contents, feces, and blood, which is correlated with the smaller blood amount of total protein and albumin.

References

  1. Clain JE, Pearson RK. Diagnosis of chronic pancreatitis: is a gold standard necessary? Surg Clin North Am. 1999;79:829-845.
  2. Yadav D, Lowenfels AB. The epidemiology of pancreatitis and pancreatic cancer. Gastroenterology. 2013;144:1252-1261.
  3. Kucheryavyy YuA, Andreev DN. Nutritional Status in Patients with Chronic Pancreatitis. J Nutritional Ther. 2014;3(3):122-132.
  4. Afghani E, Sinha A, Singh VK. An overview of the diagnosis and management of nutrition in chronic pancreatitis. Nutr Clin Pract. 2014;29:295-311.
  5. Pezzilli R, Morselli Labate AM, Ceciliato R, Frulloni L, Cavestro GM, Comparato G, Ferri B, Corinaldesi R, Gullo L. Quality of life in patients with chronic pancreatitis. Dig Liver Dis. 2005;37: 181-189.
  6. Rasmussen HH, Irtun O, Olesen SS, Drewes AM, Holst M. Nutrition in chronic pancreatitis. World J Gastroenterol. 2013;19: 7267-7275.
  7. Gachago C, Draganov PV. Pain management in chronic pancreatitis. World J Gastroenterol. 2008;14:3137-3148.
  8. Giger U, Stanga Z, DeLegge MH. Management of chronic pancreatitis. Nutr Clin Pract. 2004;19:37-49.
  9. Sikkens EC, Cahen DL, van Eijck C, Kuipers EJ, Bruno MJ. Patients with exocrine insufficiency due to chronic pancreatitis are undertreated: a Dutch national survey. Pancreatology. 2012;12: 71-73.
  10. Skipworth JR, Raptis DA, Wijesuriya S, Puthucheary Z, Olde Damink SW, Imber C, Malagò M, Shankar A. The use of nasojejunal nutrition in patients with chronic pancreatitis. JOP. 2011;12:574-580.
  11. Kalvaria I, Labadarios D, Shephard GS, Visser L, Marks IN. Biochemical vitamin E deficiency in chronic pancreatitis. Int J Pancreatol. 1986;1:119-128.
  12. Twersky Y, Bank S. Nutritional deficiencies in chronic pancreatitis. Gastroenterol Clin North Am. 1989;18:543-565.
  13. Bang UC, Benfield T, Bendtsen F, Hyldstrup L, Beck Jensen JE. The risk of fractures among patients with cirrhosis or chronic pancreatitis. Clin Gastroenterol Hepatol. 2014;12:320-326.
  14. Sikkens EC, Cahen DL, Koch AD, Braat H, Poley JW, Kuipers EJ, Bruno MJ. The prevalence of fat-soluble vitamin deficiencies and a decreased bone mass in patients with chronic pancreatitis. Pancreatology. 2013;13:238-242.
  15. Duggan SN, Smyth ND, O’Sullivan M, Feehan S, Ridgway PF, Conlon KC. The prevalence of malnutrition and fat-soluble vitamin deficiencies in chronic pancreatitis. Nutr Clin Pract. 2014;29:348-354.
  16. Glasbrenner B, Malfertheiner P, Büchler M, Kuhn K, Ditschuneit H. Vitamin B12 and folic acid deficiency in chronic pancreatitis: a relevant disorder? Klin Wochenschr. 1991;69:168-172.
  17. Girish BN, Rajesh G, Vaidyanathan K, Balakrishnan V. Zinc status in chronic pancreatitis and its relationship with exocrine and endocrine insufficiency. JOP. 2009;10:651-656.
  18. Кучерявый Ю.А., Москалева А.Б., Свиридова А.В., Сайдуллаева М.Г., Джаватханова Р.Т., Смирнов А.В., Устинова Н.Н. Нутритивный статус как фактор риска осложнений хронического панкреатита и развития панкреатической недостаточности. Экспериментальная и клиническая гастроэнтерология. 2012;7:10-16.
  19. Dujsikova H, Dite P, Tomandl J, Sevcikova A, Precechtelova M. Occurrence of metabolic osteopathy in patients with chronic pancreatitis. Pancreatology. 2008;8:583-586.
  20. Lindkvist B, Dominguez-Munoz JE, Luaces-Regueira M, Castineiras-Alvarino M, Nieto-Garcia L, Iglesias-Garcia J. Serum nutritional markers for prediction of pancreatic exocrine insufficiency in chronic pancreatitis. Pancreatology. 2012;12:305-310.
  21. Marotta F, Labadarios D, Frazer L, Girdwood A, Marks IN. Fat-soluble vitamin concentration in chronic alcohol-induced pancreatitis. Relationship with steatorrhea. Dig Dis Sci. 1994;39:993-998.
  22. Hartmann D, Felix K, Ehmann M, Schnölzer M, Fiedler S, Bogumil R, Büchler M, Friess H. Protein expression profiling reveals distinctive changes in serum proteins associated with chronic pancreatitis. Pancreas. 2007;35:334-342.
  23. Schnitzler CM, Mesquita JM, Shires RJ. Cortical and trabecular bone microarchitecture and turnover in alcohol-induced chronic pancreatitis: a histomorphometric study. Bone Miner Metab. 2010;28:456-467.
  24. Sobral-Oliveira MB, Faintuch J, Guarita DR, Oliveira CP, Carrilho FJ. Nutritional profile of asymptomatic alcoholic patients. Arq Gastroenterol. 2011;48:112-114.
  25. Haaber AB, Rosenfalck AM, Hansen B, Hilsted J, Larsen S. Bone mineral metabolism, bone mineral density, and body composition in patients with chronic pancreatitis and pancreatic exocrine insufficiency. Int J Pancreatol. 2000;27:21-27.
  26. Morillas Ariño C, Hernández Mijares A, Morillas Ariño MJ, Aparisi Quereda L, Lluch Verdú I, Ascaso Gimilio JF, Carmena Rodríguez R. Nutritional status assessment in diabetes mellitus secondary to chronic alcoholic pancreatitis. Med Clin (Barc). 1997;108:373-376.
  27. Domínguez-Muñoz JE, Iglesias-García J, Vilariño-Insua M, Iglesias-Rey M. 13C-mixed triglyceride breath test to assess oral enzyme substitution therapy in patients with chronic pancreatitis. Clin Gastroenterol Hepatol. 2007;5:484-488.
  28. Affronti J. Chronic pancreatitis and exocrine insufficiency. Prim Care. 2011;38:515-537.
  29. Armbrecht U. Chronic pancreatitis: weight loss and poor physical performance — experience from a specialized rehabilitation centre. Rehabilitation (Stuttg). 2001;40:332-336.
  30. Riediger H, Adam U, Fischer E, Keck T, Pfeffer F, Hopt UT, Makowiec F. Long-term outcome after resection for chronic pancreatitis in 224 patients. J Gastrointest Surg. 2007;11:949-959;discussion 959-960.
  31. Park JW, Jang JY, Kim EJ, Kang MJ, Kwon W, Chang YR, Han IW, Kim SW. Effects of pancreatectomy on nutritional state, pancreatic function and quality of life. Br J Surg. 2013;100:1064-1070.
  32. Ahmad SA, Edwards MJ, Sutton JM, Grewal SS, Hanseman DJ, Maithel SK, Patel SH, Bentram DJ, Weber SM, Cho CS, Winslow ER, Scoggins CR, Martin RC, Kim HJ, Baker JJ, Merchant NB, Parikh AA, Kooby DA. Factors influencing readmission after pancreaticoduodenectomy: a multi-institutional study of 1302 patients. Ann Surg. 2012;256:529-537.
  33. Petersen JM, Forsmark CE. Chronic pancreatitis and maldigestion. Semin Gastrointest Dis. 2002;13:191-199.
  34. Havala T, Shronts E, Cerra F. Nutritional support in acute pancreatitis. Gastroenterol Clin North Am. 1989;18:525-542.
  35. Di Carlo V, Nespoli A, Chiesa R, Staudacher C, Cristallo M, Bevilacqua G, Staudacher V. Hemodynamic and metabolic impairment in acute pancreatitis. World J Surg. 1981;5:329-339.
  36. Shaw JH, Wolfe RR. Glucose, fatty acid, and urea kinetics in patients with severe pancreatitis. The response to substrate infusion and total parenteral nutrition. Ann Surg. 1986;204:665-672.
  37. Hébuterne X, Hastier P, Péroux JL, Zeboudj N, Delmont JP, Rampal P. Resting energy expenditure in patients with alcoholic chronic pancreatitis. Dig Dis Sci. 1996;41:533-539.
  38. Dickerson RN, Vehe KL, Mullen JL, Feurer ID. Resting energy expenditure in patients with pancreatitis. Crit Care Med. 1991;19:484-490.
  39. Sitzmann JV, Steinborn PA, Zinner MJ, Cameron JL. Total parenteral nutrition and alternate energy substrates in treatment of severe acute pancreatitis. Surg Gynecol Obstet. 1989;168:311-317.
  40. Marulendra S, Kirby DF. Nutrition support in pancreatitis. Nutr Clin Pract. 1995;10:45-53.
  41. Chowdhury RS, Forsmark CE, Davis RH, Toskes PP, Verne GN. Prevalence of gastroparesis in patients with small duct chronic pancreatitis. Pancreas. 2003;26:235-238.
  42. Davies AR, Froomes PR, French CJ, Bellomo R, Gutteridge GA, Nyulasi I, et al. Randomized comparison of nasojejunal and nasogastric feeding in critically ill patients. Crit Care Med. 2002;30: 586-590.
  43. DiMagno EP, Go VL, Summerskill WH. Relations between pancreatic enzyme ouputs and malabsorption in severe pancreatic insufficiency. N Engl J Med. 1973;288:813-815.
  44. Cuntz U, Frank G, Lehnert P, Fichter M. Interrelationships between the size of the pancreas and the weight of patients with eating disorders. Int J Eat Disord. 2000;27:297-303.
  45. El-Hodhod MA, Nassar MF, Hetta OA, Gomaa SM. Pancreatic size in protein energy malnutrition: a predictor of nutritional recovery. Eur J Clin Nutr. 2005;59:467-473.
  46. Sauniere JF, Sarles H. Exocrine pancreatic function and protein-calorie malnutrition in Dakar and Abidjan (West Africa): silent pancreatic insufficiency. Am J Clin Nutr. 1988;48:1233-1238.
  47. Swenne I, Borg LA, Crace CJ, Schnell Landström A. Persistent reduction of pancreatic beta-cell mass after a limited period of protein-energy malnutrition in the young rat. Diabetologia. 1992;35:939-945.
  48. Volk BW, Lazarus SS. Rabbit Pancreas in Protein Malnutrition (Experimental Kwashiorkor) and after Cortisone Administration. Am J Pathol. 1960;37:121-135.
  49. Lazarus SS, Volk BW. Electron microscopy and histochemistry of rabbit pancreas in protein malnutrition (Experimental kwashiorkor). Am J Pathol. 1964;44:95-111.
  50. Blackburn WR, Vinijchaikul K. The pancreas in kwashiorkor. An electron microscopic study. Lab Invest. 1969;20:305-318.
  51. Brooks SE, Golden MH. The exocrine pancreas in kwashiorkor and marasmus. Light and electron microscopy. West Indian Med J. 1992;41:56-60.
  52. Schnelldorfer T, Adams DB. The effect of malnutrition on morbidity after surgery for chronic pancreatitis. Am Surg. 2005;71:466-472;discussion 472-473.
  53. Duggan S, O’Sullivan M, Feehan S, Ridgway P, Conlon K. Nutrition treatment of deficiency and malnutrition in chronic pancreatitis: a review. Nutr Clin Pract. 2010;25:362-370.
  54. Kyle UG, Bosaeus I, De Lorenzo AD, Deurenberg P, Elia M, Gómez JM, Heitmann BL, Kent-Smith L, Melchior JC, Pirlich M, Scharfetter H, Schols AM, Pichard C. Bioelectrical impedance analysis-part I: review of principles and methods. Clin Nutr. 2004;23:1226-1243.
  55. Kyle UG, Bosaeus I, De Lorenzo AD, Deurenberg P, Elia M, Manuel Gómez J, Lilienthal Heitmann B, Kent-Smith L, Melchior JC, Pirlich M, Scharfetter H, M W J Schols A, Pichard C. Bioelectrical impedance analysis-part II: utilization in clinical practice. Clin Nutr. 2004;23:1430-1453.
  56. Norman K, Pirlich M, Sorensen J, Christensen P, Kemps M, Schütz T, Lochs H, Kondrup J. Bioimpedance vector analysis as a measure of muscle function. Clin Nutr. 2009;28:78-82.
  57. Tieland M, Dirks ML, van der Zwaluw N, Verdijk LB, van de Rest O, de Groot LC, van Loon LJ. Protein supplementation increases muscle mass gain during prolonged resistance-type exercise training in frail elderly people: a randomized, double-blind, placebo-controlled trial. J Am Med Dir Assoc. 2012;13:713-719.
  58. Candow DG, Forbes SC, Little JP, Cornish SM, Pinkoski C, Chilibeck PD. Effect of nutritional interventions and resistance exercise on aging muscle mass and strength. Biogerontology. 2012;13:345-358.
  59. Geirsdottir OG, Arnarson A, Briem K, Ramel A, Jonsson PV, Thorsdottir I. Effect of 12-week resistance exercise program on body composition, muscle strength, physical function, and glucose metabolism in healthy, insulin-resistant, and diabetic elderly Icelanders. J Gerontol A Biol Sci Med Sci. 2012;67:1259-1265.
  60. Norman K, Stobäus N, Gonzalez MC, Schulzke JD, Pirlich M. Hand grip strength: outcome predictor and marker of nutritional status. Clin Nutr. 2011;30:135-142.
  61. Słodkowski M, Rubinsztajn R, Cebulski W, Krasnodebski IW. A case report of severe hypophosphatemia in the course of refeeding syndrome. Pol Merkur Lekarski. 2004;17:638-639.
  62. Harris JA, Benedict FG. A Biometric Study of Human Basal Metabolism. Proc Natl Acad Sci USA. 1918;4:370-373.
  63. Dhingra R, Singh N, Sachdev V, Upadhyay AD, Saraya A. Effect of antioxidant supplementation on surrogate markers of fibrosis in chronic pancreatitis: a randomized, placebo-controlled trial. Pancreas. 2013;42:589-595.
  64. White JV, Guenter P, Jensen G, Malone A, Schofield M; Academy of Nutrition and Dietetics Malnutrition Work Group; A.S.P.E.N. Malnutrition Task Force; A.S.P.E.N. Consensus statement of the academy of nutrition and Dietetics/American society for parenteral and enteral nutrition: characteristics recommended for the identification and documentation of adult malnutrition (undernutrition). J Acad Nutr Diet. 2012;112:730-738.
  65. Kondrup J, Rasmussen HH, Hamberg O, Stanga Z. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr. 2003;22:321-336.
  66. Streppel MT, de Vries JH, Meijboom S, Beekman M, de Craen AJ, Slagboom PE, Feskens EJ. Relative validity of the food frequency questionnaire used to assess dietary intake in the Leiden Longevity Study. Nutr J. 2013;12:75.
  67. Singh S, Midha S, Singh N, Joshi YK, Garg PK. Dietary counseling versus dietary supplements for malnutrition in chronic pancreatitis: a randomized controlled trial. Clin Gastroenterol Hepatol. 2008;6:353-359.
  68. Yeh YY, Zee P. Relation of ketosis to metabolic changes induced by acute medium-chain triglyceride feeding in rats. J Nutr. 1976;106:58-67.
  69. Nakajima K, Oshida H, Muneyuki T, Kakei M. Pancrelipase: an evidence-based review of its use for treating pancreatic exocrine insufficiency. Core Evid. 2012;7:77-91.
  70. Domínguez-Muñoz JE. Chronic pancreatitis and persistent steatorrhea: what is the correct dose of enzymes? Clin Gastroenterol Hepatol. 2011;9:541-546.
  71. Domínguez-Muñoz JE, Iglesias-García J. Oral pancreatic enzyme substitution therapy in chronic pancreatitis: is clinical response an appropriate marker for evaluation of therapeutic efficacy? JOP. 2010;11:158-162.
  72. Plauth M, Cabré E, Campillo B, Kondrup J, Marchesini G, Schütz T, Shenkin A, Wendon J. ESPEN Guidelines on Parenteral Nutrition: hepatology. Clin Nutr. 2009;28:436-444.
  73. Lochs H, Dejong C, Hammarqvist F, Hebuterne X, Leon-Sanz M, Schütz T, van Gemert W, van Gossum A, Valentini L, Lübke H, Bischoff S, Engelmann N, Thul P. ESPEN Guidelines on Enteral Nutrition: Gastroenterology. Clin Nutr. 2006;25:260-274.
  74. Meier RF, Beglinger C. Nutrition in pancreatic diseases. Best Pract Res Clin Gastroenterol. 2006;20:507-529.
  75. Meier R, Ockenga J, Pertkiewicz M, Pap A, Milinic N, Macfie J, Löser C, Keim V. ESPEN Guidelines on Enteral Nutrition: Pancreas. Clin Nutr. 2006;25:275-284.
  76. Gianotti L, Meier R, Lobo DN, Bassi C, Dejong CH, Ockenga J, Irtun O, MacFie J; ESPEN. ESPEN guidelines on parenteral nutrition: pancreas. Clin Nutr. 2009;28:428-435.
  77. Stanga Z, Giger U, Marx A, DeLegge MH. Effect of jejunal long-term feeding in chronic pancreatitis. J Parenter Enteral Nutr. 2005;29:12-20.
  78. Hamvas J, Schwab R, Pap A. Jejunal feeding in chronic pancreatitis with severe necrosis. J Pancreas (Online). 2001;2:112-116.
  79. Toskes PP. Update on diagnosis and management of chronic pancreatitis. Curr Gastroenterol Rep. 1999;1:145-153.
  80. Corcoy R, Sanchez JM, Domingo P, Net A. Nutrition in the patient with severe acute pancreatitis. Nutrition. 1988;4:269-275.
  81. Verlaan M, Roelofs HM, van-Schaik A, Wanten GJ, Jansen JB, Peters WH, Drenth JP. Assessment of oxidative stress in chronic pancreatitis patients. World J Gastroenterol. 2006;12:5705-5710.
  82. Morris-Stiff GJ, Bowrey DJ, Oleesky D, Davies M, Clark GW, Puntis MC. The antioxidant profiles of patients with recurrent acute and chronic pancreatitis. Am J Gastroenterol. 1999;94: 2135-2140.
  83. Valko M, Leibfritz D, Moncol J, Cronin MT, Mazur M, Telser J. Free radicals and antioxidants in normal physiological functions and human disease. Int J Biochem Cell Biol. 2007;39:44-84.
  84. McCloy R. Chronic pancreatitis at Manchester, UK. Focus on antioxidant therapy. Digestion. 1998;59(Suppl 4):36-48.
  85. Braganza JM, Schofield D, Snehalatha C, Mohan V. Micronutrient antioxidant status in tropical compared with temperatezone chronic pancreatitis. Scand J Gastroenterol. 1993;28:1098-1104.
  86. Szuster-Ciesielska A, Daniluk J, Kandefer-Szerszen M. Oxidative stress in blood of patients with alcohol-related pancreatitis. Pancreas. 2001;22:261-266.
  87. Kodydkova J, Vavrova L, Stankova B. et al. Antioxidant status and oxidative stress markers in pancreatic cancer and chronic pancreatitis. Pancreas. 2013;42:614-621.
  88. Grigsby B, Rodriguez-Rilo H, Khan K. Antioxidants and chronic pancreatitis: theory of oxidative stress and trials of antioxidant therapy. Dig Dis Sci. 2012;57:835-841.
  89. Kirk GR, White JS, McKie L, Stevenson M, Young I, Clements WD, Rowlands BJ. Combined antioxidant therapy reduces pain and improves quality of life in chronic pancreatitis. J Gastrointest Surg. 2006;10:499-503.
  90. Uden S, Bilton D, Nathan L, Hunt LP, Main C, Braganza JM. Antioxidant therapy for recurrent pancreatitis: Placebocontrolled trial. Aliment Pharmacol Ther. 1990;4:357-371.
  91. Salim AS. Role of oxygen-derived free radical scavengers in the treatment of recurrent pain produced by chronic pancreatitis. A new approach. Arch Surg. 1991;126:1109-1114.
  92. Uden S, Schofield D, Miller PF, Day JP, Bottiglier T, Braganza JM. Antioxidant therapy for recurrent pancreatitis: Biochemical profiles in a placebo-controlled trial. Aliment Pharmacol Ther. 1992;6:229-240.
  93. Bilton D, Schofield D, Mei G, Kay PM, Bottiglieri T, Braganza JM. Placebo-controlled trials of antioxidant therapy including S-adenosulmethionine in patients with recurrent non-gallstone pancreatitis. Drug Invest. 1994;8:10-20.
  94. Banks PA, Hughes M, Ferrante M, Noordhoek EC, Ramagopal V, Slivka A. Does allopurinol reduce pain of chronic pancreatitis? Int J Pancreatol. 1997;22:171-176.
  95. Durgaprasad S, Pai CG, Vasanthkumar, Alvres JF, Namitha S. A pilot study of the antioxidant effect of curcumin in tropical pancreatitis. Indian J Med Res. 2005;122:315-318.
  96. Bhardwaj P, Garg PK, Maulik SK, Saraya A, Tandon RK, Acharya SK. A randomized controlled trial of antioxidant supplementation for pain relief in patients with chronic pancreatitis. Gastroenterology. 2009;136:149-159.e2
  97. Shah NS, Makin AJ, Sheen AJ, Siriwardena AK. Quality of life assessment in patients with chronic pancreatitis receiving antioxidant therapy. World J Gastroenterol. 2010;16:4066-4071.
  98. Siriwardena AK, Mason JM, Sheen AJ, Makin AJ, Shah NS. Antioxidant therapy does not reduce pain in patients with chronic pancreatitis: the ANTICIPATE study. Gastroenterology. 2012;143:655-663.
  99. Braganza JM. Micronutrient therapy for chronic pancreatitis: premises and pitfalls. JOP. 2013;14:304-308.
  100. Talukdar R, Reddy DN. Pain in chronic pancreatitis: managing beyond the pancreatic duct. World J Gastroenterol. 2013;19: 6319-6328.
  101. Cai GH, Huang J, Zhao Y, Chen J, Wu HH, Dong YL, Smith HS, Li YQ, Wang W, Wu SX. Antioxidant therapy for pain relief in patients with chronic pancreatitis: systematic review and meta-analysis. Pain Physician. 2013;16:521-532.
  102. Bjelakovic G, Nikolova D, Gluud LL, Simonetti RG, Gluud C. Mortality in randomized trials of antioxidant supplements for primary and secondary prevention: systematic review and meta-analysis. JAMA. 2007;297:842-857.

Supplementary files

Supplementary Files
Action
1. JATS XML

Copyright (c) 2016 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
 

Address of the Editorial Office:

  • Novij Zykovskij proezd, 3, 40, Moscow, 125167

Correspondence address:

  • Alabyan Street, 13/1, Moscow, 127055, Russian Federation

Managing Editor:

  • Tel.: +7 (926) 905-41-26
  • E-mail: e.gorbacheva@ter-arkhiv.ru

 

© 2018-2021 "Consilium Medicum" Publishing house


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies