Nutritional parameters following first episode of pediatric acute pancreatitis.

Autor: Orkin S; Department of Pediatrics, College of Medicine, University of Cincinnati, USA; Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, USA. Electronic address: sarah.orkin@cchmc.org., Holovach P; Department of Pediatrics, College of Medicine, University of Cincinnati, USA., Thompson T; Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, USA., Farrell P; Department of Pediatrics, College of Medicine, University of Cincinnati, USA; Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, USA., Nasr A; Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, USA., Vitale D; Department of Pediatrics, College of Medicine, University of Cincinnati, USA; Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, USA., Ibrahim S; Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, USA., Kotha N; Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, USA., Estes J; Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, USA., Hornung L; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, USA., Abu-El-Haija M; Department of Pediatrics, College of Medicine, University of Cincinnati, USA; Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, USA.
Jazyk: angličtina
Zdroj: Clinical nutrition ESPEN [Clin Nutr ESPEN] 2024 Oct; Vol. 63, pp. 409-416. Date of Electronic Publication: 2024 Jul 01.
DOI: 10.1016/j.clnesp.2024.06.050
Abstrakt: Background and Objectives: Acute pancreatitis (AP) carries the risk of subsequent nutritional deficiencies. The prevalence of these deficiencies following a single episode of AP in children is unknown. We aimed to determine prevalence of anthropometric and laboratory-based measures of nutritional status in children following their first (index) admission for AP.
Methods: Prospective observational cohort study of patients ≤21 years of age with first episode of confirmed AP. Anthropometric and laboratory values were obtained at time of AP onset and at follow up time points of 3 and 12 months (m) post AP. AP attack was classified as either: mild, moderately severe or severe (which were combined in one group (SAP)).
Results: 181 patients met criteria and were followed prospectively with 52% male, a median age of 13.7 years (IQR 9.4-16.0) and median Body Mass Index (BMI) Z-score of 0.6 (IQR -0.5, 1.6). Most patients had mild AP (140, 77%), with 23% meeting criteria for moderate or severe (41/181). 6 (3%) had diabetes mellitus (DM) predating AP and were excluded from further analysis. BMI Z-score remained stable during the follow up period. 13% of patients developed pre-DM or DM at 3m or 12m. Nearly one third of patients had low ferritin at 3m (29%) or 12m (29%). At 12m, 8% of patients had Vitamin A deficiency. 6% of patients had low Vitamin E levels at 3m and 5% at 12m. Over half of patients at both 3m and 12m had 25 OH Vitamin D insufficiency or deficiency (56% and 56%). Prolonged International Normalized Ratio (INR) (>1.3) was seen in 9% of patients at 12m. Very low albumin (<3.5 g/dL) was found in 24% of patients at 3m and 18% at 12m (Table 1). Patients with very low albumin at 3m were younger (median 10.7 vs. 14.2 years, p = 0.04), however sex, BMI Z-score and AP severity were not associated with albumin level. Although BMI Z-score did not differ between the groups, those with SAP had a significant decrease in BMI Z-score from first attack compared to mild AP at 3m (-0.4 vs. 0.0, p = 0.0002, Figure 2). At 3m, Vitamin E deficiency in SAP versus mild AP was found in 20% vs 2% (p = 0.04) and SAP had a lower median hematocrit (35.8 vs. 37.6, p = 0.046). There were no other laboratory significant differences at 3m in mild versus SAP groups. At 12m, those with SAP were more likely to have pre-DM or DM compared to mild AP (31% vs. 7%, p = 0.002). No other significant laboratory differences occurred at 12m.
Conclusions: After the first AP attack patients experience nutritional deficiencies, including ferritin, all fat-soluble vitamins, and low albumin. SAP is associated with a decrease in BMI Z-score, increased prevalence of vitamin E deficiency at 3m, and an increase in pre-diabetes and diabetes at 12m. Serial monitoring of vitamin and mineral values post AP is warranted and further prospective studies are needed.
Competing Interests: Declaration of competing interest The authors have no conflicts of interest relevant to this article to disclose.
(Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)
Databáze: MEDLINE
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