Rosalie H Bartels1, Sophie L Meyer2, Tijs A Stehmann2, Céline Bourdon3, Robert H J Bandsma4, Wieger P Voskuijl5. 1. Global Child Health Group, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands; Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi. Electronic address: r.h.bartels@amc.uva.nl. 2. University Medical Center Groningen, University of Groningen, The Netherlands. 3. Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, University of Toronto, Toronto, Canada. 4. Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, University of Toronto, Toronto, Canada; Department of Pediatrics, Center for Liver, Digestive and Metabolic Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada. 5. Global Child Health Group, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands; Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi.
Abstract
OBJECTIVES: To assess whether pancreatic function is impaired in children with severe acute malnutrition, is different between edematous vs nonedematous malnutrition, and improves by nutritional rehabilitation. STUDY DESIGN: We followed 89 children with severe acute malnutrition admitted to Queen Elizabeth Central Hospital in Blantyre, Malawi. Stool and blood samples were taken on admission and 3 days after initial stabilization to determine exocrine pancreatic function via fecal elastase-1 (FE-1) and serum trypsinogen and amylase levels. RESULTS: A total of 33 children (37.1%) had nonedematous severe acute malnutrition, whereas 56 (62.9%) had edematous severe acute malnutrition. On admission, 92% of patients showed evidence of pancreatic insufficiency as measured by FE-1 <200 μg/g of stool. Patients with edematous severe acute malnutrition were more likely to have low FE-1 (98% vs 82.8%, P = .026). FE-1 levels remained low in these individuals throughout the assessment period. Serum trypsinogen was elevated (>57 ng/mL) in 28% and amylase in 21% (>110 U/L) of children, suggesting pancreatic inflammation. CONCLUSION: Exocrine pancreatic insufficiency is prevalent in children with severe acute malnutrition and especially in children with edematous severe acute malnutrition. In addition, biochemical signs suggestive of pancreatitis are common in children with severe acute malnutrition. These results have implications for standard rehabilitation treatment of children with severe acute malnutrition who may benefit from pancreatic enzyme replacement therapy. TRIAL REGISTRATION: ISRCTN.com: 13916953.
OBJECTIVES: To assess whether pancreatic function is impaired in children with severe acute malnutrition, is different between edematous vs nonedematous malnutrition, and improves by nutritional rehabilitation. STUDY DESIGN: We followed 89 children with severe acute malnutrition admitted to Queen Elizabeth Central Hospital in Blantyre, Malawi. Stool and blood samples were taken on admission and 3 days after initial stabilization to determine exocrine pancreatic function via fecal elastase-1 (FE-1) and serum trypsinogen and amylase levels. RESULTS: A total of 33 children (37.1%) had nonedematous severe acute malnutrition, whereas 56 (62.9%) had edematous severe acute malnutrition. On admission, 92% of patients showed evidence of pancreatic insufficiency as measured by FE-1 <200 μg/g of stool. Patients with edematous severe acute malnutrition were more likely to have low FE-1 (98% vs 82.8%, P = .026). FE-1 levels remained low in these individuals throughout the assessment period. Serum trypsinogen was elevated (>57 ng/mL) in 28% and amylase in 21% (>110 U/L) of children, suggesting pancreatic inflammation. CONCLUSION: Exocrine pancreatic insufficiency is prevalent in children with severe acute malnutrition and especially in children with edematous severe acute malnutrition. In addition, biochemical signs suggestive of pancreatitis are common in children with severe acute malnutrition. These results have implications for standard rehabilitation treatment of children with severe acute malnutrition who may benefit from pancreatic enzyme replacement therapy. TRIAL REGISTRATION: ISRCTN.com: 13916953.
Authors: Zulfiqar A Bhutta; James A Berkley; Robert H J Bandsma; Marko Kerac; Indi Trehan; André Briend Journal: Nat Rev Dis Primers Date: 2017-09-21 Impact factor: 52.329
Authors: Rosalie H Bartels; Emmanuel Chimwezi; Victoria Watson; Leilei Pei; Isabel Potani; Benjamin Allubha; Kate Chidzalo; Duolao Wang; Queen Dube; Macpherson Mallewa; Angela Allen; Robert H J Bandsma; Wieger P Voskuijl; Stephen J Allen Journal: Sci Rep Date: 2019-02-19 Impact factor: 4.379
Authors: Robert H J Bandsma; Wieger Voskuijl; Emmanuel Chimwezi; Greg Fegan; André Briend; Johnstone Thitiri; Moses Ngari; Laura Mwalekwa; Victor Bandika; Rehema Ali; Fauzat Hamid; Betty Owor; Neema Mturi; Isabel Potani; Benjamin Allubha; Anneke C Muller Kobold; Rosalie H Bartels; Christian J Versloot; Marjon Feenstra; Deborah A van den Brink; Patrick F van Rheenen; Marko Kerac; Celine Bourdon; James A Berkley Journal: PLoS Med Date: 2019-02-26 Impact factor: 11.069