Clinical types of nutritional status in patients with chronic pancreatitis

Background: Malnutrition is among the predictors of unfavorable outcome of chronic pancreatitis (CP). Our previous study has shown that the malnutrition prevalence in CP patients was 92%; body mass index (BMI) ≤ 19  kg/m2 was found only in 15.5%.Aim: To identify clinical variants of nutrition status...

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Main Authors: L. Yu. Ilchenko, N. S. Gavrilina, I. G. Nikitin
Format: Article
Language:Russian
Published: MONIKI 2019-12-01
Series:Alʹmanah Kliničeskoj Mediciny
Subjects:
Online Access:https://www.almclinmed.ru/jour/article/view/1175
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author L. Yu. Ilchenko
N. S. Gavrilina
I. G. Nikitin
author_facet L. Yu. Ilchenko
N. S. Gavrilina
I. G. Nikitin
author_sort L. Yu. Ilchenko
collection DOAJ
description Background: Malnutrition is among the predictors of unfavorable outcome of chronic pancreatitis (CP). Our previous study has shown that the malnutrition prevalence in CP patients was 92%; body mass index (BMI) ≤ 19  kg/m2 was found only in 15.5%.Aim: To identify clinical variants of nutrition status in CP patients. Materials and methods: We have analyzed the data from the first step of an open-label randomized prospective study on 148  patients (80  male) with CP of various etiologies, aged from  22 to  82  years (mean age, 51.8 ± 13.2  years). According to TIGAR-O, the patients were allocated into two groups: the first group with chronic alcoholic pancreatitis (CAP) included 71 patients (57 male and 14  female, mean age 46.3 ± 11.2  years), the second one with chronic obstructive pancreatitis (COP) consisted of 77  patients (29  male and 48  female; mean age 56.81 ± 3  years). Exocrine pancreatic function was assessed by fecal elastase 1  levels. Nutritional status was determined by V.M. Luft classification based on comparison of various anthropometrical parameters, as well as on some laboratory parameters (hemoglobin, total protein, albumin levels, lymphocyte counts, etc.). The anthropometrical and laboratory parameters, as well as smoking and alcohol overconsumption were included into the correlational analysis.Results: In the CAP group, the number of smoking patients was 2.5-fold higher than that in the COP group (р < 0.001). The smokers had a  lower BMI (р = 0.002) and lower pre-albumin levels (р = 0.04), compared to the non-smokers. There were associations between: the number of cigarettes per day and the daily amount of alcohol (r = 0.55), the smoking index and thickness of the skin/fat fold over the triceps muscle of the arm (r = -0.4), severity of chronic alcohol abuse and malnutrition grade (r = -0.5), duration of excess alcohol consumption and thickness of the skin/fat fold over the triceps (r = -0.4), hemoglobin levels and malnutrition grade (r = 0.5), hemoglobin level and shoulder circumference (r = 0.47), blood cholesterol level and shoulder circumference (r = 0.37), low density lipoprotein level and shoulder circumference (r = 0.41). Four basic clinical types of nutrition status could be identified: malnutrition of various grades (66%), overweight/obesity without malnutrition (3%), sarcopenic obesity with some malnutrition (26%), euthrophic type (5%). In the patients with malnutrition without sarcopenia, the etiology of CP had no effect on the prevalence of malnutrition. Low albumin levels were found in 54%  (80/98) of the patients with pancreatic exocrine insufficiency and malnutrition, indicating a  risk of sarcopenia. Sarcopenic obesity with malnutrition was most prevalent in COP (24  vs. 14  patients with CAP) and at higher age (56.8  vs. 46.3  years, respectively, р < 0.001).Conclusion: Smoking, chronic alcohol abuse, low hemoglobin levels are associated (negative correlation) with the development of malnutrition in CP patients. The most prevalent clinical types of nutrition status in CP patients are characterized by various degrees of malnutrition, as well as by malnutrition with sarcopenic obesity.
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spelling doaj.art-b8253cc1fe2c4d40bc25a16f93e16b382022-12-21T22:28:47ZrusMONIKIAlʹmanah Kliničeskoj Mediciny2072-05052587-92942019-12-0147651852410.18786/2072-0505-2019-47-065676Clinical types of nutritional status in patients with chronic pancreatitisL. Yu. Ilchenko0N. S. Gavrilina1I. G. Nikitin2Pirogov Russian National Research Medical University; Moscow City Clinical Hospital after V.M. BuyanovPirogov Russian National Research Medical University; Moscow City Clinical Hospital after V.M. BuyanovPirogov Russian National Research Medical University; Moscow City Clinical Hospital after V.M. Buyanov; Centre of Medical RehabilitationBackground: Malnutrition is among the predictors of unfavorable outcome of chronic pancreatitis (CP). Our previous study has shown that the malnutrition prevalence in CP patients was 92%; body mass index (BMI) ≤ 19  kg/m2 was found only in 15.5%.Aim: To identify clinical variants of nutrition status in CP patients. Materials and methods: We have analyzed the data from the first step of an open-label randomized prospective study on 148  patients (80  male) with CP of various etiologies, aged from  22 to  82  years (mean age, 51.8 ± 13.2  years). According to TIGAR-O, the patients were allocated into two groups: the first group with chronic alcoholic pancreatitis (CAP) included 71 patients (57 male and 14  female, mean age 46.3 ± 11.2  years), the second one with chronic obstructive pancreatitis (COP) consisted of 77  patients (29  male and 48  female; mean age 56.81 ± 3  years). Exocrine pancreatic function was assessed by fecal elastase 1  levels. Nutritional status was determined by V.M. Luft classification based on comparison of various anthropometrical parameters, as well as on some laboratory parameters (hemoglobin, total protein, albumin levels, lymphocyte counts, etc.). The anthropometrical and laboratory parameters, as well as smoking and alcohol overconsumption were included into the correlational analysis.Results: In the CAP group, the number of smoking patients was 2.5-fold higher than that in the COP group (р < 0.001). The smokers had a  lower BMI (р = 0.002) and lower pre-albumin levels (р = 0.04), compared to the non-smokers. There were associations between: the number of cigarettes per day and the daily amount of alcohol (r = 0.55), the smoking index and thickness of the skin/fat fold over the triceps muscle of the arm (r = -0.4), severity of chronic alcohol abuse and malnutrition grade (r = -0.5), duration of excess alcohol consumption and thickness of the skin/fat fold over the triceps (r = -0.4), hemoglobin levels and malnutrition grade (r = 0.5), hemoglobin level and shoulder circumference (r = 0.47), blood cholesterol level and shoulder circumference (r = 0.37), low density lipoprotein level and shoulder circumference (r = 0.41). Four basic clinical types of nutrition status could be identified: malnutrition of various grades (66%), overweight/obesity without malnutrition (3%), sarcopenic obesity with some malnutrition (26%), euthrophic type (5%). In the patients with malnutrition without sarcopenia, the etiology of CP had no effect on the prevalence of malnutrition. Low albumin levels were found in 54%  (80/98) of the patients with pancreatic exocrine insufficiency and malnutrition, indicating a  risk of sarcopenia. Sarcopenic obesity with malnutrition was most prevalent in COP (24  vs. 14  patients with CAP) and at higher age (56.8  vs. 46.3  years, respectively, р < 0.001).Conclusion: Smoking, chronic alcohol abuse, low hemoglobin levels are associated (negative correlation) with the development of malnutrition in CP patients. The most prevalent clinical types of nutrition status in CP patients are characterized by various degrees of malnutrition, as well as by malnutrition with sarcopenic obesity.https://www.almclinmed.ru/jour/article/view/1175chronic pancreatitismalnutritionsarcopenic obesityfecal elastase-1
spellingShingle L. Yu. Ilchenko
N. S. Gavrilina
I. G. Nikitin
Clinical types of nutritional status in patients with chronic pancreatitis
Alʹmanah Kliničeskoj Mediciny
chronic pancreatitis
malnutrition
sarcopenic obesity
fecal elastase-1
title Clinical types of nutritional status in patients with chronic pancreatitis
title_full Clinical types of nutritional status in patients with chronic pancreatitis
title_fullStr Clinical types of nutritional status in patients with chronic pancreatitis
title_full_unstemmed Clinical types of nutritional status in patients with chronic pancreatitis
title_short Clinical types of nutritional status in patients with chronic pancreatitis
title_sort clinical types of nutritional status in patients with chronic pancreatitis
topic chronic pancreatitis
malnutrition
sarcopenic obesity
fecal elastase-1
url https://www.almclinmed.ru/jour/article/view/1175
work_keys_str_mv AT lyuilchenko clinicaltypesofnutritionalstatusinpatientswithchronicpancreatitis
AT nsgavrilina clinicaltypesofnutritionalstatusinpatientswithchronicpancreatitis
AT ignikitin clinicaltypesofnutritionalstatusinpatientswithchronicpancreatitis