Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Clinical nutrition, enteral and parenteral nutrition

Nutritional status in patients with chronic pancreatitis

European Journal of Clinical Nutrition volume 67, pages 1271–1276 (2013)Cite this article

Subjects

Abstract

Objective:

Chronic pancreatitis (CP) patients have an increased risk of malnutrition. Information about nutritional status of CP outpatients is scarce, and simple, sensitive methods to identify patients at risk are lacking. This explorative cross-sectional study was performed to survey the nutritional status of CP outpatients.

Subjects:

Fifty patients with chronic or recurrent acute pancreatitis (RAP) had a nutritional assessment performed. Scores on nutritional screening tools and a quality of life questionnaire were assessed. General observations and relations between parameters were described.

Results:

Thirty-nine patients had CP and eleven patients had RAP. According to the nutritional screening tools, 28–50% of the patients had a moderate or high risk of malnutrition. All domains of the Short Form Health Survey were significantly lowered in CP patients (all P⩽0.001) compared with the Dutch norm values. A considerable number of patients scored below the 5th percentile on anthropometric measures. Mini Nutritional Assessment could not identify all patients with very low anthropometric scores. Substantial weight loss was not a sensitive indicator for functional impairment.

Conclusion:

CP outpatients are at risk of malnutrition. Currently used screening methods (for example, weight loss) are likely to be not sensitive enough to identify all patients with impaired body composition and restricted function. Therefore, some patients with objective decline in nutritional status will remain unidentified. An extended nutritional assessment is recommendable in CP patients.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Meier RF, Beglinger C . Nutrition in pancreatic diseases. Best Pract Res Clin Gastroenterol 2006; 20: 507–529.

    Article  CAS  Google Scholar 

  2. Regunath H, Shivakumar BM, Kurien A, Satyamoorthy K, Pai CG . Anthropometric measurements of nutritional status in chronic pancreatitis in India: comparison of tropical and alcoholic pancreatitis. Indian J Gastroenterol 2011; 30: 78–83.

    Article  Google Scholar 

  3. Apte MV, Pirola RC, Wilson JS . Malnutrition as a cause of chronic pancreatitis: myth dispelled? J Gastroenterol Hepatol 2008; 23: 1312–1314.

    Article  Google Scholar 

  4. Midha S, Singh N, Sachdev V, Tandon RK, Joshi YK, Garg PK . Cause and effect relationship of malnutrition with idiopathic chronic pancreatitis: prospective case-control study. J Gastroenterol Hepatol 2008; 23: 1378–1383.

    Article  Google Scholar 

  5. Nakamura T, Takeuchi T . Pancreatic steatorrhea, malabsorption, and nutrition biochemistry: a comparison of Japanese, European, and American patients with chronic pancreatitis. Pancreas 1997; 14: 323–333.

    Article  CAS  Google Scholar 

  6. Pezzilli R, Morselli Labate AM, Ceciliato R, Frulloni L, Cavestro GM, Comparato G et al. Quality of life in patients with chronic pancreatitis. Dig Liver Dis 2005; 37: 181–189.

    Article  CAS  Google Scholar 

  7. Wehler M, Reulbach U, Nichterlein R, Lange K, Fischer B, Farnbacher M et al. Health-related quality of life in chronic pancreatitis: a psychometric assessment. Scand J Gastroenterol 2003; 38: 1083–1089.

    Article  CAS  Google Scholar 

  8. White JV, Guenter P, Jensen G, Malone A, Schofield M . Consensus statement: Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition: characteristics recommended for the identification and documentation of adult malnutrition (undernutrition). JPEN J Parenter Enteral Nutr 2012; 36: 275–283.

    Article  Google Scholar 

  9. Beglinger C . Diagnosis of chronic pancreatitis. Dig Dis 2010; 28: 359–363.

    Article  Google Scholar 

  10. Braganza JM, Lee SH, McCloy RF, McMahon MJ . Chronic pancreatitis. Lancet 2011; 377: 1184–1197.

    Article  CAS  Google Scholar 

  11. Testoni PA, Caporuscio S, Bagnolo F, Lella F . Idiopathic recurrent pancreatitis: long-term results after ERCP, endoscopic sphincterotomy, or ursodeoxycholic acid treatment. Am J Gastroenterol 2000; 95: 1702–1707.

    Article  CAS  Google Scholar 

  12. Frisancho AR . Anthropometric standards for the assessment of growth and nutritional status. 1 edn, University of Michigan Press: Ann Arbor, MI, USA, 1990.

    Book  Google Scholar 

  13. Department of Dietetics MUMC. Dutch Reference Values on Hand Grip Strength. Maastricht: Maastricht University Medical Center; (updated on 2011; cited on December 2012); Available from http://www.nutritionalassessment.azm.nl/algoritme+na/onderzoek/functionele+parameters/nederlandse+normaalwaarden+hkk.htm.

  14. Kyle UG, Genton L, Karsegard L, Slosman DO, Pichard C . Single prediction equation for bioelectrical impedance analysis in adults aged 20—94 years. Nutrition 2001; 17: 248–253.

    Article  CAS  Google Scholar 

  15. Schutz Y, Kyle UU, Pichard C . Fat-free mass index and fat mass index percentiles in Caucasians aged 18-98 y. Int J Obes Relat Metab Disord 2002; 26: 953–960.

    Article  CAS  Google Scholar 

  16. Hardt PD, Marzeion AM, Schnell-Kretschmer H, Wusten O, Nalop J, Zekorn T et al. Fecal elastase 1 measurement compared with endoscopic retrograde cholangiopancreatography for the diagnosis of chronic pancreatitis. Pancreas 2002; 25: e6–e9.

    Article  Google Scholar 

  17. Ewald N, Kaufmann C, Raspe A, Kloer HU . Bretzel RG, Hardt PD. Prevalence of diabetes mellitus secondary to pancreatic diseases (type 3c). Diabetes Metab Res Rev 2012; 28: 338–342.

    Article  CAS  Google Scholar 

  18. Aaronson NK, Muller M, Cohen PD, Essink-Bot ML, Fekkes M, Sanderman R et al. Translation, validation, and norming of the Dutch language version of the SF-36 Health Survey in community and chronic disease populations. J Clin Epidemiol 1998; 51: 1055–1068.

    Article  CAS  Google Scholar 

  19. Kyle UG, Pirlich M, Lochs H, Schuetz T, Pichard C . Increased length of hospital stay in underweight and overweight patients at hospital admission: a controlled population study. Clin Nutr 2005; 24: 133–142.

    Article  Google Scholar 

  20. Hornby ST, Nunes QM, Hillman TE, Stanga Z, Neal KR, Rowlands BJ et al. Relationships between structural and functional measures of nutritional status in a normally nourished population. Clin Nutr 2005; 24: 421–426.

    Article  CAS  Google Scholar 

  21. Soeters PB, Reijven PL, van Bokhorst-de van der Schueren MA, Schols JM, Halfens RJ, Meijers JM et al. A rational approach to nutritional assessment. Clin Nutr 2008; 27: 706–716.

    Article  Google Scholar 

  22. van Venrooij LM, de Vos R, Zijlstra E, Borgmeijer-Hoelen MM, van Leeuwen PA, de Mol BA . The impact of low preoperative fat-free body mass on infections and length of stay after cardiac surgery: a prospective cohort study. J Thorac Cardiovasc Surg 2011; 142: 1263–1269.

    Article  Google Scholar 

  23. Schols AM, Broekhuizen R, Weling-Scheepers CA, Wouters EF . Body composition and mortality in chronic obstructive pulmonary disease. Am J Clin Nutr 2005; 82: 53–59.

    Article  CAS  Google Scholar 

  24. Pichard C, Kyle UG, Morabia A, Perrier A, Vermeulen B, Unger P . Nutritional assessment: lean body mass depletion at hospital admission is associated with an increased length of stay. Am J Clin Nutr 2004; 79: 613–618.

    Article  CAS  Google Scholar 

  25. Steiner MC, Barton RL, Singh SJ, Morgan MD . Bedside methods versus dual energy X-ray absorptiometry for body composition measurement in COPD. Eur Respir J 2002; 19: 626–631.

    Article  CAS  Google Scholar 

  26. Soler-Cataluna JJ, Sanchez-Sanchez L, Martinez-Garcia MA, Sanchez PR, Salcedo E, Navarro M . Mid-arm muscle area is a better predictor of mortality than body mass index in COPD. Chest 2005; 128: 2108–2115.

    Article  Google Scholar 

  27. Sanchez FF, Faganello MM, Tanni SE, Lucheta PA, Pelegrino NG, Hasegawa SH et al. Anthropometric midarm measurements can detect systemic fat-free mass depletion in patients with chronic obstructive pulmonary disease. Braz J Med Biol Res 2011; 44: 453–459.

    Article  CAS  Google Scholar 

  28. Haverkort EB, Binnekade JM, de Haan RJ, van Bokhorst-de van der Schueren MA . Handgrip strength by dynamometry does not identify malnutrition in individual preoperative outpatients. Clin Nutr 2012; 31: 647–651.

    Article  Google Scholar 

  29. Quilliot D, Walters E, Bonte JP, Fruchart JC, Duriez P, Ziegler O . Diabetes mellitus worsens antioxidant status in patients with chronic pancreatitis. Am J Clin Nutr 2005; 81: 1117–1125.

    Article  CAS  Google Scholar 

  30. Van Gossum A, Closset P, Noel E, Cremer M, Neve J . Deficiency in antioxidant factors in patients with alcohol-related chronic pancreatitis. Dig Dis Sci 1996; 41: 1225–1231.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Maastricht University Medical Center, Maastricht, The Netherlands

    B P M Verhaegh, A A M Masclee & Y C A Keulemans

  2. Department of Dietetics, Maastricht University Medical Center, Maastricht, The Netherlands

    P L M Reijven & J H M Brouns

  3. Department of Epidemiology, Maastricht University, Maastricht, The Netherlands

    M H Prins

Authors
  1. B P M Verhaegh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P L M Reijven
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M H Prins
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J H M Brouns
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A A M Masclee
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Y C A Keulemans
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to B P M Verhaegh.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Verhaegh, B., Reijven, P., Prins, M. et al. Nutritional status in patients with chronic pancreatitis. Eur J Clin Nutr 67, 1271–1276 (2013). https://doi.org/10.1038/ejcn.2013.199

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ejcn.2013.199

Keywords

This article is cited by

Search

Advanced search

Quick links