Exocrine pancreatic function and protein-calorie malnutrition in Dakar and Abidjan (West Africa): silent pancreatic insufficiency.

Pancreatic function was measured by duodenal aspiration after injection of secretin and cholecystokinin in malnourished children from Dakar and Abidjan, West Africa, and in age- and sex-matched control subjects from Dakar, Abidjan, and Marseille, France. Compared with French control subjects, pancreatic function was moderately decreased in Abidjan control subjects and more severely in Abidjan subjects with kwashiorkor. Pancreatic insufficiency was as severe in patients as in control subjects in Dakar. After a well-balanced diet was fed for 5 d, all kwashiorkor symptoms disappeared. In Abidjan pancreatic secretion levels increased but remained lower than in control subjects. After 28 d feeding, the pancreatic secretion of kwashiorkor patients in Dakar was not modified. Pancreatic extracts had no effect on changes in pancreatic insufficiency after feeding. In West Africa there is a latent pancreatic insufficiency involving water, electrolytes, and enzymes, which is more severe in Dakar, where, in contrast to Abidjan, it is neither aggravated by kwashiorkor nor corrected by feeding.