Pancreatic exocrine function and morphology following prior malnutrition in Asian and African cohorts: a multi-cohort study

Abstract

BACKGROUND: Studies of survivors of large 20th-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. OBJECTIVES: We tested the hypothesis that severe wasting malnutrition in childhood or adulthood leads to long-term exocrine pancreatic insufficiency and/or structural abnormalities. METHODS: We followed up participants from 6 cohorts of previously malnourished (PM) and not previously malnourished (NPM) adults and children in India, the Philippines, Tanzania, and Zambia. Fecal 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 odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: A total of 2165 participants had assessments of pancreatic structure or exocrine function: 1799 (83%) had FE-1 measured, 1761 (81%) underwent USS, and 329 (15%) had CT. Low FE-1 (<200 μg/g) was found in 252 (32%) of 791 PM and 346 (34%) of 1008 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 with Asian cohorts, which was not due to inflammation or human immunodeficiency virus infection. Circulating trypsinogen was associated with pancreatic size only after adjusting for body weight. CONCLUSIONS: In this large multicohort study, prior severe malnutrition did not result in exocrine pancreatic dysfunction later in life, although 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.