Patrick S Ngoya, Mizinga Jacqueline Tembo, Sana Ahmed, Dixi Paglinawan-Modoc, Molly Chisenga, Belinda Kweka, Julius Patrick Ferrer, Evangelista Malindisa, Riddhi Dasgupta, Dorothea Nitsch, Sharon E Cox, Christina Christoffersen, Ruth Frikke-Schmidt, Nanette R Lee, George PrayGod, James A M Shaw, Geeta Trilok-Kumar, Suzanne Filteau, Juan Antonio Solon, Paul Kelly
In this large multi-cohort study, prior severe malnutrition did not result in exocrine pancreatic dysfunction later in life, though pancreatic size was increased in adults, reduced in children, and varied between cohorts. These findings highlight the need for further research into the long-term metabolic and nutritional consequences of early-life malnutrition across diverse populations.
BACKGROUND: Studies of survivors of large twentieth century famines suggest persistent after-effects on metabolism and nutrient handling, including abnormal endocrine and exocrine pancreatic functions, which play key roles in nutrient digestion and absorption.
OBJECTIVE: We tested the hypothesis that severe wasting malnutrition in childhood or adulthood leads to long-term exocrine pancreatic insufficiency (EPI) and/or structural abnormalities.
METHODS: We followed up participants from six cohorts of previously malnourished (PM) and not previously malnourished (NPM) adults and children in India, the Philippines, Tanzania, and Zambia. Faecal elastase (FE-1), circulating trypsinogen, amylase and lipase assays were performed. Ultrasound scans (USS) were conducted in all cohorts, and a subset of adults underwent Computed Tomography scan (CT) to estimate pancreatic volume. Statistical analyses included Kruskal-Wallis tests and logistic regression to estimate ORs and 95% CIs.
RESULTS: A total of 2,165 participants had assessments of pancreatic structure or exocrine function: 1,799 (83%) had faecal elastase-1 (FE-1) measured, 1,761 (81%) underwent USS, and 329 (15%) had CT. Low FE-1 (below 200μg/g) was found in 252 (32%) of 791 previously malnourished (PM) and 346 (34%) of 1,008 not previously malnourished (NPM participants) (OR 0.89; 95%CI 0.73, 1.10; P=0.29). Radiological measurements of the pancreas were consistently higher in PM than NPM adult participants when adjusted for body weight; this association was reversed in children. Pancreatic volume was apparently higher, and FE-1 lower, in African compared to Asian cohorts, which was not due to inflammation or human immunodeficiency virus (HIV) infection. Circulating trypsinogen was associated with pancreatic size only after adjusting for body weight.
CONCLUSIONS: In this large multi-cohort study, prior severe malnutrition did not result in exocrine pancreatic dysfunction later in life, though pancreatic size was increased in adults, reduced in children, and varied between cohorts. These findings highlight the need for further research into the long-term metabolic and nutritional consequences of early-life malnutrition across diverse populations.