title: Both Exocrine Pancreatic Insufficiency and Signs of Pancreatic Inflammation Are Prevalent in Children with Complicated Severe Acute Malnutrition: An Observational Study.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  ISRCTN.com: 13916953.
authors.affiliation: 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.
authors.forename: Rosalie H
authors.initials: RH
authors.lastname: Bartels
authors.affiliation: University Medical Center Groningen, University of Groningen, The Netherlands.
authors.forename: Sophie L
authors.initials: SL
authors.lastname: Meyer
authors.affiliation: University Medical Center Groningen, University of Groningen, The Netherlands.
authors.forename: Tijs A
authors.initials: TA
authors.lastname: Stehmann
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, University of Toronto, Toronto, Canada.
authors.forename: Céline
authors.initials: C
authors.lastname: Bourdon
authors.affiliation: 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.
authors.forename: Robert H J
authors.initials: RH
authors.lastname: Bandsma
authors.affiliation: 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.
authors.forename: Wieger P
authors.initials: WP
authors.lastname: Voskuijl
mesh_terms: D000681:Amylases / Q000097:blood; D002675:Child, Preschool; D015331:Cohort Studies; D010188:Exocrine Pancreatic Insufficiency / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D010196:Pancreatic Elastase / Q000378:metabolism; D010186:Pancreatic Function Tests; D010195:Pancreatitis / Q000453:epidemiology*; D015995:Prevalence; D000067011:Severe Acute Malnutrition / Q000150:complications*; D014362:Trypsinogen / Q000097:blood
chemical_list: D014362:Trypsinogen; D000681:Amylases; D010196:Pancreatic Elastase
keywords: amylase; exocrine pancreatic insufficiency; fecal elastase-1; pancreatic inflammation; trypsinogen