title: Pancreatic exocrine insufficiency in malnourished children and those with persistent diarrhoeae.
abstract: OBJECTIVE
  Persistent diarrhoea, a serious health problem, is closely related to malnutrition. Children with severe malnutrition have a 9-fold risk of death, and children with severe stunting have a 4-fold risk of death. Prolonged mucosal injury from diarrhoea causes reduced secretin and cholecystokinin secretion, which decreases stimulation to the pancreas, and is indicated by faecal elastase-1 levels. This further aggravates persistent diarrhoea and malnutrition because of the low levels of digestive enzyme production. This study evaluated the exocrine function of the pancreas in children with persistent diarrhoea and malnutrition.
  
  
  METHODS
  This study used a cross-sectional design to compare exocrine pancreatic function among children with persistent diarrhoea, children with malnutrition, and apparently healthy children as reference Children aged 6-60 months were selected from the inpatient and outpatient units of various general hospitals in Jakarta. Faecal elastase- 1 levels were used to determine exocrine pancreatic function.
  
  
  RESULTS
  The median values of faecal elastase- 1 in children with persistent diarrhoea, children with malnutrition, and reference children were 743 (1-1503) mcg/g, 861 (17-2909) mcg/g, and 1210 (26-3000) mcg/g, respectively. A significant difference was observed in the faecal elastase-1 levels between reference children and those with persistent diarrhoea (p<0.001). However, no differences in the faecal elastase-1 levels were noted between malnourished and reference children (p>0.05). Children with both persistent diarrhoea and malnutrition showed mean FE-1 392.3±206.9 and median 419 (125- 593).
  
  
  CONCLUSIONS
  Exocrine pancreatic insufficiency is found in children with persistent diarrhoea. Children with combined persistent diarrhoea and malnutrition have the lowest FE-1, to which persistent diarrhea has the most significant contribution.
authors.affiliation: Gastrohepatology Division, Department of Pediatrics, Harapan Kita Women and Children Hospital, Jakarta, Indonesia. Email: dr.ariani@gmail.com.
authors.forename: Ariani Dewi
authors.initials: AD
authors.lastname: Widodo
authors.affiliation: Department of Clinical Pathology, Faculty of Medicine Universitas Indonesia/Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
authors.forename: Ina S
authors.initials: IS
authors.lastname: Timan
authors.affiliation: Department of Clinical Nutrition, Faculty of Medicine Universitas Indonesia/Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
authors.forename: Saptawati
authors.initials: S
authors.lastname: Bardosono
authors.affiliation: General Practitioner, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.
authors.forename: Widdy
authors.initials: W
authors.lastname: Winarta
authors.affiliation: Gastrohepatology Division, Department of Child Health, Faculty of Medicine Universitas Padjajaran/Dr Hasan Sadikin Hospital, Bandung, Indonesia.
authors.forename: Dwi
authors.initials: D
authors.lastname: Prasetyo
authors.affiliation: Gastrohepatology Division, Department of Child Health, Faculty of Medicine Universitas Indonesia/Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
authors.forename: Agus
authors.initials: A
authors.lastname: Firmansyah
mesh_terms: D016022:Case-Control Studies; D002648:Child; D015362:Child Nutrition Disorders; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003967:Diarrhea / Q000150:complications*; D010188:Exocrine Pancreatic Insufficiency / Q000150:complications*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male