Abstract
Background: Chronic pancreatitis (CP) patients frequently experience malabsorption and maldigestion, leading to micronutrient and macronutrient deficiencies. Comorbid diabetes and lifestyle habits, such as alcohol consumption, may impact nutrition status. Methods: We compared micronutrient antioxidant, bone metabolism, serum protein, and inflammatory marker levels in 301 CP patients and 266 controls with no known pancreatic disease. We analyzed serum prealbumin and retinol binding protein; vitamins A, D, E, and B12; osteocalcin; tumor necrosis factor-α; and C-reactive protein (CRP). We also evaluated biomarkers among subsets of patients, examining factors including time since diagnosis, body mass index, alcohol as primary etiology, diabetes mellitus, vitamin supplementation, and pancreatic enzyme replacement. Results: After correcting for multiple comparisons, CP patients had significantly lower levels than controls of the following: vitamin A (40.9 vs 45.4 μg/dL) and vitamin E (α-tocopherol [8.7 vs 10.3 mg/L] and γ-tocopherol [1.8 vs 2.2 mg/L]), as well as osteocalcin (7.9 vs 10 ng/mL) and serum prealbumin (23 vs 27 mg/dL). Both patients and controls who took vitamin supplements had higher serum levels of vitamins than those not taking supplements. Compared with controls, in controlled analyses, CP patients had significantly lower levels of vitamins A, D, and E (both α-tocopherol and γ-tocopherol). CP patients also had significantly lower levels of osteocalcin, serum prealbumin, and retinol binding protein, and higher CRP. Conclusions: CP patients demonstrated lower levels of selected nutrition and bone metabolism biomarkers than controls. Diabetes and alcohol did not impact biomarkers. Vitamin supplements and pancreatic enzyme replacement therapy improved nutrition biomarkers in CP patients.
| Original language | English |
|---|---|
| Pages (from-to) | 387-399 |
| Number of pages | 13 |
| Journal | Nutrition in Clinical Practice |
| Volume | 34 |
| Issue number | 3 |
| DOIs | |
| State | Published - Jun 2019 |
Bibliographical note
Publisher Copyright:© 2018 American Society for Parenteral and Enteral Nutrition
Funding
Financial disclosures: This research was partly supported by AbbVie, Inc. MET-11-0033 (J.B.G.), NIH DK061451 (D.C.W.), DK077906 (D.Y.), U01 DK108327 (D.C.), U01 DK108320 (C.E.F.), U01 DK108306 (D.C.W. and D.Y.), and UL1 RR024153 and UL1TR000005. J. B. Greer and D. C. Whitcomb equally contributed to the conception and design of the research; D. Yadav contributed to the design of the research; P. Greer, B. S. Sandhu, S. Alkaade, C. M. Wilcox, M. A. Anderson, S. Sherman, T. B. Gardner, M. D. Lewis, N. M. Guda, T. Muniraj, D. Conwell, G. A. Cote, C. E. Forsmark, P. A. Banks, G. Tang, A. Gelrud, R. E. Brand, A. Slivka, K. Stello, and D. Yadav contributed to the acquisition and analysis of data; P. Greer, G. Tang and D. Yadav contributed to the interpretation of the data; and J. B. Greer drafted the manuscript. All authors critically revised the manuscript, agree to be fully accountable for ensuring the integrity and accuracy of the work, and read and approved the final manuscript. The authors would like to acknowledge the Epidemiology Data Center, Michael O'Connell, PhD, Division of Gastroenterology & Hepatology at the University of Pittsburgh for the data management of NAPS2-CV and NAPS2-AS studies, Danielle Dwyer for genotyping and laboratory management, and other members of the NAPS2 consortium.
| Funders | Funder number |
|---|---|
| Abbvie, Inc. | |
| Division of Gastroenterology & Hepatology at the University of Pittsburgh | NAPS2-CV, NAPS2-AS |
| National Institute of Diabetes and Digestive and Kidney Diseases | R01DK061451 |
| National Institute of Diabetes and Digestive and Kidney Diseases |
Keywords
- chronic pancreatitis
- inflammation
- malabsorption
- micronutrient deficiency
- pancreatic enzyme replacement therapy
- steatorrhea
ASJC Scopus subject areas
- Medicine (miscellaneous)
- Nutrition and Dietetics
