Fecal pancreatic elastase-1 levels in older individuals without known gastrointestinal diseases or diabetes mellitus.
BACKGROUND
Structural changes occur in the pancreas as a part of the natural aging process. With aging, also the incidence of maldigestive symptoms and malnutrition increases, raising the possibility that these might be caused at least in part by inadequate pancreatic enzyme secretion due to degenerative processes and damage of the gland. Fecal elastase-1 is a good marker of pancreatic exocrine secretion. The aim of this study was to investigate the fecal elastase-1 levels among over 60 years old Finnish and Polish healthy individuals without any special diet, known gastrointestinal disease, surgery or diabetes mellitus.


METHODS
A total of 159 patients participated in this cross-sectional study. 106 older individuals (aged 60-92 years) were recruited from outpatient clinics and elderly homes. They were divided to three age groups: 60-69 years old (n = 31); 70-79 years old (n = 38) and over 80 years old (n = 37). 53 young subjects (20-28 years old) were investigated as controls. Inclusion criteria were age over 60 years, normal status and competence. Exclusion criteria were any special diet, diabetes mellitus, any known gastrointestinal disease or prior gastrointestinal surgery. Fecal elastase-1 concentration was measured from stool samples with an ELISA that uses two monoclonal antibodies against different epitopes of human elastase-1.


RESULTS
Fecal elastase-1 concentrations correlated negatively with age (Pearson r = -0,3531, P < 0.001) and were significantly lower among subjects over 70 years old compared to controls (controls vs. 70-79 years old and controls vs. over 80 years old, both P < 0.001). Among the over 60 years old subjects, the fecal elastase-1 concentrations were below the cut off level of 200 μg/g in 23 of 106 (21.7%) individuals [mean 112 (86-138) μg/g] indicating pancreatic exocrine insufficiency. Of those, 9 subjects had fecal elastase-1 level below 100 μg/g as a marker of severe pancreatic insufficiency.


CONCLUSIONS
In our study one fifth of healthy older individuals without any gastrointestinal disorder, surgery or diabetes mellitus suffer from pancreatic exocrine insufficiency and might benefit from enzyme supplementation therapy.
Department of Biotechnology and Molecular Medicine, AI Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland. karl-heinz.herzig@oulu.fi
Karl-Heinz
KH
Herzig
Anna-Kaisa
AK
Purhonen
Kati M
KM
Räsänen
Joanna
J
Idziak
Petri
P
Juvonen
Ryszard
R
Phillps
Jaroslaw
J
Walkowiak
D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology; D003430:Cross-Sectional Studies; D010188:Exocrine Pancreatic Insufficiency / Q000201:enzymology / Q000453:epidemiology; D005243:Feces / Q000737:chemistry*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010196:Pancreatic Elastase / Q000032:analysis*
D010196:Pancreatic Elastase
Gastroenterology. 1992 Mar;102(3):895-901
1537525
Pancreatology. 2003;3(5):395-402
14526149
Am J Gastroenterol. 1984 May;79(5):382-8
6720660
Scand J Gastroenterol. 1999 Feb;34(2):202-7
10192202
J Pediatr Gastroenterol Nutr. 2003 Apr;36(4):474-8
12658038
Aktuelle Gerontol. 1982 Mar;12(2):40-3
6123268
Pancreatology. 2009;9(3):240-4
19407477
Am J Gastroenterol. 2010 Oct;105(10):2276-86
20502447
Hum Pathol. 1984 Jul;15(7):677-83
6745910
Gut. 1996 Oct;39(4):580-6
8944569
Scand J Gastroenterol. 2001 Oct;36(10):1092-9
11589385
Eur J Clin Invest. 2001 May;31(5):425-30
11380594
Int J Pancreatol. 1988 Dec;3(6):497-502
2464656
J Gastroenterol. 2006 Sep;41(9):901-8
17048055
Scand J Gastroenterol. 2001 Oct;36(10):1056-61
11589378
Acta Diabetol. 2000;37(3):105-10
11277309
Digestion. 1991;50(3-4):202-11
1812045
Virchows Arch. 2005 Nov;447(5):800-5
16021508
Gut. 1998 Apr;42(4):551-4
9616319
Z Gastroenterol. 2001 Oct;39(10):823-30
11605150
Clin Gastroenterol Hepatol. 2010 May;8(5):433-8
19835990
J Clin Gastroenterol. 2009 Feb;43(2):165-70
18797409
Scand J Gastroenterol. 2004 Jun;39(6):607-8
15223689
Eur J Gastroenterol Hepatol. 1996 Nov;8(11):1117-20
8944376
J Am Geriatr Soc. 1986 Nov;34(11):790-2
3771978
Dig Dis Sci. 1999 Jan;44(1):210-3
9952246
Virchows Arch A Pathol Anat Histol. 1976 Aug 23;371(2):145-52
824797
Best Pract Res Clin Gastroenterol. 2010 Jun;24(3):337-47
20510833
Am J Gastroenterol. 2004 Jul;99(7):1350-4
15233677
Scand J Gastroenterol. 2005 Jun;40(6):697-704
16036530
Diabetes Care. 2003 Jan;26(1):61-9
12502659