Defining the rate of nutritional and metabolic derangements after pancreatic resection

K L Percy; Y X Ooi; C B Nahm; F Simpson; G Hickey; S Sahni; D Chesher; M Itchins; N Pavlakis; V H Tsang; R Clifton-Bligh; A J Gill; J S Samra; A Mittal

doi:10.1016/j.pan.2022.07.014

Defining the rate of nutritional and metabolic derangements after pancreatic resection

Pancreatology. 2022 Nov;22(7):1028-1034. doi: 10.1016/j.pan.2022.07.014. Epub 2022 Aug 1.

Authors

K L Percy¹, Y X Ooi², C B Nahm³, F Simpson⁴, G Hickey⁵, S Sahni⁶, D Chesher⁷, M Itchins⁸, N Pavlakis⁸, V H Tsang⁹, R Clifton-Bligh⁹, A J Gill¹⁰, J S Samra¹¹, A Mittal¹²

Affiliations

¹ Nutrition Services, Royal North Shore Hospital, St. Leonards, NSW, Australia. Electronic address: Karen.Percy@health.nsw.gov.au.
² Nutrition Services, Royal North Shore Hospital, St. Leonards, NSW, Australia; Sydney Vital, Sydney, NSW, Australia.
³ Sydney Vital, Sydney, NSW, Australia; Upper GI Surgical Unit, Royal North Shore Hospital, St. Leonards, NSW, Australia; Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
⁴ Nutrition Services, Royal North Shore Hospital, St. Leonards, NSW, Australia; Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
⁵ Nutrition Services, Royal North Shore Hospital, St. Leonards, NSW, Australia.
⁶ Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
⁷ Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Biochemistry, Royal North Shore Hospital, St. Leonards, NSW, Australia.
⁸ Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Medical Oncology, Royal North Shore Hospital, St. Leonards, NSW, Australia.
⁹ Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Endocrinology, Royal North Shore Hospital, St. Leonards, NSW, Australia.
¹⁰ Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Australian Pancreatic Centre, Sydney, NSW, Australia; Cancer Diagnosis and Pathology Group, Kolling Institute, The University of Sydney, Australia.
¹¹ Upper GI Surgical Unit, Royal North Shore Hospital, St. Leonards, NSW, Australia; NSW Health Pathology, Macquarie University, North Ryde, NSW, Australia; Australian Pancreatic Centre, Sydney, NSW, Australia.
¹² Upper GI Surgical Unit, Royal North Shore Hospital, St. Leonards, NSW, Australia; Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Australian Pancreatic Centre, Sydney, NSW, Australia; University of Notre Dame Australia, Australia.

PMID: 35948507
DOI: 10.1016/j.pan.2022.07.014

Abstract

Background and aims: Pancreatic resection is associated with pancreatic exocrine insufficiency (PEI) leading to nutritional consequences. The Pancreatic Nutrition Clinic was established to diagnose and manage PEI through standardised nutritional assessment. In this prospective observational study, we aimed to define the rate of PEI, diabetes mellitus and nutritional abnormalities in patients who underwent pancreatic resection.

Methods: All Pancreatic Nutrition Clinic patients were included for analysis. Clinical data were prospectively obtained at initial assessment. Biochemical data included micronutrient levels, faecal elastase-1 and haemoglobin A1c. Bone mineral density and nutritional assessment were undertaken.

Results: Ninety-eight patients were included. Fifty-nine per cent (58/98) had undergone a pancreatoduodenectomy. Ninety-three patients had a faecal elastase-1 result, 65% (60/93) of which had a faecal elastase-1 less than 200 μg/g of faeces. Seventy-five patients (76%) of the total population required PERT, and thirty-nine (40%) were classified as malnourished using the patient-generated subjective global assessment tool. Seventy-two per cent (70/97) had a biochemical deficiency of one or more micronutrients. Thirty-eight people (39%) had diabetes mellitus. Of the seventy-eight patients with a bone mineral density scan available for analysis, 29% (23/78) had osteoporosis and 49% (38/78) osteopenia.

Conclusions: Pancreatic exocrine insufficiency, micronutrient deficiency, bone disease, diabetes mellitus and malnutrition are highly prevalent in patients who have undergone pancreatic resection.

Keywords: Diabetes mellitus; Enzymes; Nutrition; Osteoporosis; Pancreas.

Publication types

Observational Study

MeSH terms

Diabetes Mellitus*
Exocrine Pancreatic Insufficiency* / diagnosis
Humans
Malnutrition*
Metabolic Diseases*
Micronutrients
Pancreatic Elastase / analysis

Substances

Pancreatic Elastase
Micronutrients