Keywords
How to Cite
Abstract views: 330 PDF Downloads: 453
Abstract
The review presents literature data on the importance of nutritional goals, which include ensuring sufficient intake of macro- and micronutrients, reducing indigestion, the degree of malabsorption, and other risk factors in order to prevent or treat malnutrition associated with exocrine pancreatic insufficiency. Nutritional status and nutritional interventions depend on this. Attention is drawn to the indication of different nutritional options depending on the severity of the course of exocrine insufficiency and the presence of diabetes (10–15% need oral nutritional supplements, 5% — enteral nutrition through a tube, and about 1% — parenteral nutrition). The European Society for Clinical Nutrition and Metabolism (ESPEN) Guidelines for Nutritional Screening are presented. The question of the impact of chronic pancreatitis and exocrine pancreatic insufficiency on digestion with the development of maldigestion and malabsorption and the importance of these factors for the quality of life is discussed. The author reviewed in detail the metabolism of carbohydrates, proteins, and fats in enzyme pancreatic insufficiency and the importance of this knowledge in providing nutritional recommendations. The digestion of lipids in the lumen of the small intestine depends on pancreatic lipase and cofactors such as colipase and bile acids. Lipases of the stomach and salivary glands play a minor role in the digestion of triglycerides and cannot compensate for the insufficient fat digestion. There are no enzyme systems for digesting triglycerides in the brush border membrane. Therefore, lipid digestion is reduced due to insufficient secretion of lipase and a decrease in the concentration of bile acids in the lumen. Attention is paid to research methods that determine the state of fat, lean mass, muscle state, bone health, and resting energy expenditure, provide an opportunity to conduct a detailed assessment of current and usual food consumption, which promotes successful treatment.
References
Armbrecht U. Chronic pancreatitis: weight loss and poor physical performance — experience from a specialized rehabilitation centre. Rehabilitation (Stuttg). 2001. Vol. 40, No 6. P. 332–336.
Bang U. C., Benfield T., Bendtsen F., Hyldstrup L., Jensen J. E. B. The risk of fractures among patients with cirrhosis or chronic pancreatitis. Clin. Gastroenterol. Hepatol. 2014. Vol. 12, No 2. P. 320–326.
Duggan S., O’Sullivan M., Feehan S., Ridgway P., Conlon K. Nutrition treatment of deficiency and malnutrition in chronic pancreatitis: a review. Nutr. Clin. Pract. 2010. Vol. 25, No 4. P. 362–370.
Dujsikova H., Dite P., Tomandl J., Sevcikova A., Precechtelova M. Occurrence of metabolic osteopathy in patients with chronic pancreatitis. Pancreatology. 2008. Vol. 8, No 6. P. 583–586.
Frokjaer J., Olesen S. S., Drewes A. M. Fibrosis, atrophy and ductal pathology in chronic pancreatitis are associated with pancreatic function but independent of symptoms. Pancreas. 2013. Vol. 42, No 7. P. 1182–1187.
Geirsdottir O. G., Arnarson A., Briem K., Ramel A., Jonsson P. V., Thorsdottir I. Effect of 12-week resistance exercise program on body composition, muscle strength, physical function, and glucose metabolism in healthy, insulin-resistant, and diabetic elderly Icelanders. J. Gerontol. A. Biol. Sci. Med. Sci. 2012. Vol. 67, No 11. P. 1259–1265.
Haaber A. B., Rosenfalck A. M., Hansen B., Hilsted J., Larsen S. Bone mineral metabolism, bone mineral density, and body composition in patients with chronic pancreatitis and pancreatic exocrine insufficiency. Int. J. Pancreatol. 2000. Vol. 27. P. 21–27.
Hébuterne X., Hastier P., Péroux J. L., Zeboudj N., Delmont J. P., Rampal P. Resting energy expenditure in patients with alcoholic chronic pancreatitis. Dig. Dis. Sci. 1996. Vol. 41. P. 533–539.
Jensen G. L. Inflammation: an expanding universe. Nutr. Clin. Pract. 2008. Vol. 23, No 1. P. 1–2.
Jie B., Jiang Z. M., Nolan M. T., Zhu S. N., Yu K., Kondrup J. Impact of preoperative nutritional support on clinical outcome in abdominal surgical patients at nutritional risk. Nutrition. 2012. Vol. 28, No 10. P. 1022–1027.
Johansen N., Kondrup J., Plum L. M., Bak L., Nørregaard P., Bunch E., Baernthsen H., Andersen J. R., Larsen I. H., Martinsen A. Effect of nutritional support on clinical outcome in patients at nutritional risk. Clin. Nutr. 2004. Vol. 23, No 4. P. 539–550.
Kondrup J., Allison S. P., Elia M., Vellas B., Plauth M. ESPEN guidelines for nutrition screening 2002. Clin. Nutr. 2003. Vol. 22, No 4. P. 415–421.
Norman K., Stobäus N., Gonzalez M. C., Schulzke J. D., Pirlich M. Hand grip strength: outcome predictor and marker of nutritional status. Clin. Nutr. 2011. Vol. 30, No 2. P. 135–142.
Plauth M., Cabré E., Campillo B., Kondrup J., Marchesini G., Schütz T., Shenkin A., Wendon J. ESPEN Guidelines on Parenteral Nutrition: hepatology. Clin. Nutr. 2009. Vol. 28, No 4. P. 436–444.
Rasmussen H. H., Kondrup J., Staun M., Ladefoged K., Kristensen H., Wengler A. Prevalence of patients at nutritional risk in Danish hospitals. Clin. Nutr. 2004. Vol. 23, No 5. P. 1009–1015.
Riediger H., Adam U., Fischer E., Keck T., Pfeffer F., Hopt U. T., Makowiec F. Long-term outcome after resection for chronic pancreatitis in 224 patients. J. Gastrointest. Surg. 2007. Vol. 11. P. 949–959.
Salgueiro M. J., Krebs N., Zubillaga M. B., Weill R., Postaire E., Lysionek A. E., Caro R. A., De Paoli T., Hager A., Boccio J. Zinc and diabetes mellitus: is there a need of zinc supplementation in diabetes mellitus patients? Biol. Trace Elem. Res. 2001. Vol. 81. P. 215–228.
Seres D. S., Valcarcel M., Guillaume A. Advantages of enteral nutrition over parenteral nutrition. Therap. Adv. Gastroenterol. 2013. Vol. 6, No 2. P. 157–167.
Sikkens E. C., Cahen D. L., van Eijck C., Kuipers E. J., Bruno M. J. Patients with exocrine insufficiency due to chronic pancreatitis are undertreated: a Dutch national survey. Pancreatology. 2012. Vol. 12, No 1. P. 71–73.
Singh S., Midha S., Singh N., Joshi Y. K., Garg P. K. Dietary counseling versus dietary supplements for malnutrition in chronic pancreatitis: a randomized controlled trial. Clin. Gastroenterol. Hepatol. 2008. Vol. 6, No 3. P. 353–359.
Słodkowski M., Rubinsztajn R., Cebulski W., Krasnodebski I. W. A case report of severe hypophosphatemia in the course of refeeding syndrome. Pol. Merkur. Lekarski. 2004. Vol. 17. P. 638–639.
Sorensen J., Kondrup J., Prokopowicz J., Schiesser M., Krähenbühl L., Meier R., Liberda M. EuroOOPS: an international, multicentre study to implement nutritional risk screening and evaluate clinical outcome. Clin. Nutr. 2008. Vol. 27, No 3. P. 340–349.
Streppel M. T., de Vries J. H., Meijboom S., Beekman M., de Craen A. J., Slagboom P. E., Feskens E. J. Relative validity of the food frequency questionnaire used to assess dietary intake in the Leiden Longevity Study. Nutr. J. 2013. Vol. 12. P. 75.
Weimann A., Braga M., Harsanyi L., Laviano A., Ljungqvist O., Soeters P., Jauch K. W., Kemen M., Hiesmayr J. M., Horbach T., Kuse E. R. ESPEN Guidelines on Enteral Nutrition: Surgery including organ transplantation. Clin. Nutr. 2006. Vol. 25, No 2. P. 224–244.